A Treatment Option for Esophageal Intramural Pseudodiverticulosis

Abstract

Introduction: Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition often presenting with esophageal strictures. Associated conditions reported in the literature include diabetes, alcoholism, gastroesophageal reflux disease (GERD), and dysmotility. Treatment is often limited to endoscopic dilatation and treatment of the underlying esophageal pathology. We present a case of a patient with EIPD managed successfully with dilatation and sucralfate. Case Presentation: A 58-year-old female was admitted to the hospital with several months of progressive dysphagia and a 20-pound weight loss. Her medical history was significant for GERD, for which she was only prescribed famotidine due to a prior anaphylactic allergy to proton pump inhibitors (PPIs). A barium esophogram showed a smooth mid-esophageal stricture, as well as several intramural diverticula and intramural tracts. An upper endoscopy revealed the stricture, measuring 5 mm in diameter. Distal to the stricture the esophagus appeared “ratty,” with innumerable shallow depressions. The patient was diagnosed with EIPD. A series of weekly balloon dilatations was performed with minimal success in increasing the luminal diameter. Multiple biopsies showed histologic evidence of esophagitis and no malignancy or alternative diagnoses. The patient was then prescribed sucralfate suspension. Subsequent dilatations were successful and the patient's dysphagia resolved.FigureFigureDiscussion: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder that can be associated with GERD. In patients who are unable to take PPIs, the addition of sucralfate may enhance the success of dilatations of esophageal strictures.