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

Abstract

Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review. Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities. Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

“…In a recent series, almost half of all patients had at least one food bolus impaction; many had more, and one had five within 4 years 15,27 . These cases often require emergency endoscopy and must not be misinterpreted as EoE 11,28 …”

“…In the 60 years since its discovery, only about 320 cases of DEIPD have been reported worldwide. 11 Therefore, it was thought to be an exceptionally rare condition. [2][3][4]7,12 That changed only recently with the advent of high-resolution endoscopy and searchable clinical databases.…”

“…15,27 These cases often require emergency endoscopy and must not be misinterpreted as EoE. 11,28 Risk factors for developing esophageal pseudo-diverticulosis are fairly clear. The first patient ever reported by Mendl was a 56-year-old mine worker who drank 8-12 pints (approx.…”

“…In the 60 years since its discovery, only about 320 cases of DEIPD have been reported worldwide 11 . Therefore, it was thought to be an exceptionally rare condition 2–4,7,12 .…”

“…As esophageal pseudo‐diverticulosis is a chronic, fibrosing inflammatory disease, the question arises: what causes the inflammation?—We do not know. Alcohol and tobacco abuse are established risk factors, but since these are common and the disease is rare, additional causes must exist 4,11,13,15 . In principle, these could be infectious, allergic, or autoimmune.…”