Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo-diverticulosis

Abstract

Introduction With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. Methods Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms.Results In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). Conclusion With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.

Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review

“…Both diseases may present with dysphagia, food impaction, regurgitation, and chest pain [4][5][6][7]. This has been shown recently [8] where dysphagia was present in 62 % and food bolus impaction (single or repeated) in 48 % of EIPD. In addition, EGD may be suspicious of EoE because the mucosal alterations can be similar to EoE as shown in our case (▶ Fig.…”

“…1a-c). This has been reported in the literature where even a potential association between EoE and EIPD was described [4][5][6][7][8]. In addition, in the paper by Scaffidi et al [7], 16 patients with EIPD (n = 11) and EIPD/EoE (n = 5) were compared.…”

“…Significant differences between both groups were age (mean ± SD, EIPD 58.1 ± 15.9 vs. EIPD/EoE 34.8 ± 6.4 years), allergies (18.1 vs. 100 %), bolus food obstruction (36.4 vs. 100 %), pseudodiverticulosis proximal/mid-to -distal/diffuse esophagus (81.8/9.1/9.1 vs. 0/100/0 %), endoscopic features of EoE (0 vs. 100 %). In addition, another retrospective study [8] described "EoE-like" mucosal changes with a rigid, narrowed lumen with multiple rings ("trachealization") in 76 % of cases with EIPD. This is in line with our patient initially suspected as EoE.…”

“…EIPD leads to dysphagia, bolus obstruction, chest pain, and weight loss. EIPD may be confounded with eosinophilic esophagitis (EoE) seen with increasing frequency in gastrointestinal endoscopy, because both diseases present with similar symptomatology and mucosal alteration [4][5][6][7][8]. We present a case with EIPD and a literature overview.…”

Beyond Neoplasia and Motility Disorders: An Uncommon Case of Dysphagia Owing to a Benign Stricture

“…Esophageal pseudodiverticulosis is a rare condition, hypothesized to result from a blockage of the excretory ducts of the submucosal glands, resulting in pseudodiverticula formation. 1 Comorbidities potentially associated include gastroesophageal reflux disease, eosinophilic esophagitis, alcoholism, candidiasis, malnutrition, and diabetes mellitus. Abnormalities in esophageal motility have also been associated with esophageal pseudodiverticulosis.…”