Esophageal Intramural Pseudodiverticulosis Research Articles

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Esophageal intramural pseudodiverticulosis.

Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.

Dysphagia and stenosis secondary to intramural esophageal pseudodiverticulosis.

We present the case of a patient with smoking, alcoholism, cirrhosis and HIV who was endoscopically diagnosed with esophageal candidiasis due to an episode of dysphagia. After treatment with antifungals and PPIs, the patient remained asymptomatic for almost 3 years. He presented an event of food impaction that was resolved by an upper endoscopy in which an esophageal stenosis and multiple esophageal pseudodiverticulosis were visualized. The biopsies only showed chronic nonspecific esophagitis. The stenosis was dilated with a balloon and PPIs were continued, with good response. Esophageal intramural pseudodiverticulosis is rare and can lead to motor disorders and strictures. It has a doubtful association with HIV and a clearer relationship with alcoholism, smoking, diabetes, reflux and candidiasis. The endoscopic diagnosis can be difficult so in order to make an accurate diagnosis is necessary an esophagram or CT. Treatment is based on controlling risk factors and dilating stenosis. The prognosis is usually favorable.

Esophageal Intramural Pseudodiverticulosis Diagnosed by Combining Esophagogastroduodenoscopy, Esophagography, and High-resolution manometry: A Case Report.

Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease. A 78-year-old man with dysphagia presented to our hospital. The presence of diffuse esophageal spasm was suspected by his primary-care doctor. High-resolution manometry (HRM) showed no abnormal findings. The patient was diagnosed with EIPD and Candida esophagitis, by esophagogastroduodenoscopy (EGD) and esophagography. His symptoms improved after symptomatic treatment for Candida esophagitis with oral administration of an antifungal drug. EIPD should be considered in patients with dysphagia; EGD and esophagography should be performed when diagnosing EIPD.

Intrapapillary capillary loop abundance on nonmagnified blue laser imaging in esophageal intramural pseudodiverticulosis.

To the Editor: A 61-year-old male patient with critical alcohol consumption presented with progressive dysphagia and several self-resolved bolus impactions. Index endoscopy indicated a high-grade stricture at 22 cm, warranting passage with a pediatric gastroscope, along with small openings consistent with esophageal intramural pseudodiverticulosis (EIPD). In the distal esophagus, a Schatzki ring emerged with additional pseudodiverticulae. The patient underwent esophageal bougienage to 14 mm. Image-enhanced endoscopy before scheduled repeat bougienage was perfomed, highlighting proximal EIPD on linked color imaging (Fig. 1A).1 Furthermore, linked color imaging illustrated diffuse spots correlating with what has been designated as the “faux uni” pattern on white light endoscopy.2 Apart from illustrating active movements with variations of orifice sizes, further characterization using blue laser imaging (BLI) confirmed absent submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were clearly appreciated (Fig. 1B). This finding was accentuated in scarred and pseudodiverticula-bearing segments, suggesting EIPD inflammation-driven microvascular alterations (Fig. 1C). Notwithstanding that IPCL changes notably on magnification endoscopy have been reported in other benign esophageal diseases, such as eosinophilic and/or lymphocytic esophagitis (both excluded in this patient), IPCL alterations have never been reported in EIPD nor in any other chronic inflammatory esophageal disorder on nonmagnified conditions (Fig. 1D). Of note, pathology indicating unspecific chronic inflammation did exclude dysplastic changes.Figure 1.: (A) Linked color imaging (LCI) illustrating esophageal intramural pseudodiverticulosis with several small pseudodivertiular openings alongside diffuse so-called “faux uni” spots. (B) Blue laser imaging (BLI) confirmative of absence of submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were noted, potentially correlating with type 2 IPLCs (dilation and elongation) on magnified endoscopy. (C, D) This latter abundance in IPCL potentially attributable to inflammation-driven microvascular alterations was concentrated in segments with marked intramural pseudodiverticulosis and clearly discernible under nonmagnification endoscopy.While the concept of IPCLs, relying on magnification image-enhanced endoscopy, has been developed to highlight early squamous cell dysplasia and neoplasia, its potential role in chronic inflammatory esophageal diseases awaits further evolution.3 Albeit not validated for nonenhanced endoscopic assessment, the findings in this patient may suggest IPLC type 2 with uniform dilation and elongation, likewise suggesting a benign condition.4 Conflicts of interest The authors report no conflicts of interest.

Verrucous Carcinoma Within a Segment of Esophageal Intramural Pseudodiverticulosis

Verrucous Carcinoma Within a Segment of Esophageal Intramural Pseudodiverticulosis

S2446 A Unique Endoscopic Finding in an HIV/AIDS Patient With Dysphagia

Introduction: There are many etiologies of dysphagia in patients with HIV/AIDS, including infection, structural issues, or medications. A broad differential is needed to properly diagnose and treat these patients. Here, we present a case of dysphagia in an HIV/AIDS patient related to esophageal intramural pseudodiverticulosis (EIPD). Case Description/Methods: A 58-year-old man with HIV/AIDS presented with a 2-week history of dysphagia. He had been non-compliant with highly active antiretroviral therapy (HAART), and his CD4 count at presentation was noted to be < 20. His past medical history was notable for hypertension, chronic kidney disease, Candida esophagitis, and Mallory-Weiss syndrome. He underwent an esophagogastroduodenoscopy (EGD), which revealed numerous outpouchings and white plaques in the mid esophagus (Figures 1a and b). Esophageal brushings confirmed Candida infection, and biopsies were positive for cytomegalovirus (CMV). A barium esophagram showed outpouchings throughout the esophagus, without any evidence of perforation (Figure 1c). No stricture was evident on EGD or barium esophagram. The patient was diagnosed with EIPD and treated with fluconazole, a proton pump inhibitor, and valganciclovir, with improvement in symptoms. Discussion: EIPD is characterized by the development of multiple small flask-shaped outpouchings in the esophagus. Patients with reflux esophagitis, Candida esophagitis, diabetes mellitus, HIV, and eosinophilic esophagitis are at higher risk for developing EIPD. There are approximately 250 published cases of EIPD in the literature, and the prevalence of EIPD is estimated to be 5-50 per 100,000 cases. Development of pseudodiverticula in the esophagus is suggested to be secondary to chronic inflammation, obstruction of the submucosal glands due to debris, or increased intraluminal pressure proximal to a luminal obstruction. The diagnosis is primarily made with EGD, barium esophagram, or computerized tomography. The treatment for EIPD includes treatment of underlying conditions and endoscopic dilation of strictures when they are present [1]. Our patient had several risk factors for development of EIPD such as Candida esophagitis, Mallory-Weiss syndrome, and HIV. However, a prior association between EIPD and CMV esophagitis has not been reported. Here, we highlight CMV esophagitis as a potential risk factor for development of EIPD.Figure 1.: EGD (a and b) and barium esophagram (c) findings.

S2316 Esophageal Pseudodiverticulosis Presenting as Chest Pain, Epigastric Pain and Nausea

Introduction: Esophageal intramural Pseudodiverticulosis (EIP) is an unusual condition manifested by tiny flask-shaped out pouches in the wall of the esophagus. We describe a case of a 68-year-old woman presenting for upper endoscopy (EGD) for an abnormal CT Scan showing esophageal thickening. Case Description/Methods: A 68-year-old woman presenting for EGD for an abnormal CT Scan showing esophageal thickening. This was seen as a finding on CT Angio Chest/Abdomen performed to rule aortic dissection as the patient complained of persistent chest pain. The chest pain was associated with epigastric discomfort and nausea. On EGD, the findings were consistent with the esophageal pseudodiverticulum located throughout the length but mainly in the distal esophagus. Accompanying the pseudodiverticulosis were whitish punctate plaques scattered throughout the length of the esophagus. The remainder of the exam on EGD was normal. The biopsy findings were consistent with esophagitis, in the areas where multiple esophageal psuedodiverticuli were found. The PAS stain was negative for fungal infection. The patient was prescribed Omeprazole 40 mg daily for esophagitis and was also offered treatment for Esophageal Candidiasis due to findings of white punctate plaques in the esophagus (Figure). Discussion: Esophageal Intramural Pseudodiverticulosis is an uncommon condition first described by Mendl et al. in 1960. EIP is mainly a disease of older age with a 3:2 male to female ratio. In 90% of the cases of EIP, esophagitis is found as in our patient. Esophageal Candidiasis is commonly associated with EIP. These Intramural Pseudodiverticulosis are dilated excretory ducts of the deep esophageal mucosal glands. Treatment is required in about 90% of the patients. Treatment mainly consists of PPI therapy in cases of esophagitis and dilatation in Esophageal Strictures. Antifungal therapy is indicated in suspected Esophageal Candidiasis cases as candida infection is also associated with EIP.Figure 1.: In this image, whitish plaques are seen. We can also see pseudodiverticula (marked by arrows).

S2322 Esophageal Intra-Mural Pseudo-Diverticulosis With Candidiasis

Introduction: Esophageal intramural pseudo-diverticulosis (EIPD) is a rare disorder of idiopathic etiology characterized by the presence of multiple small outpouchings protruding from the esophageal lumen. Diagnosis is typically made through radiological imaging or with esophagogastroduodenoscopy (EGD). While asymptomatic by itself, symptoms arise from associated conditions including candidiasis, esophageal stricture, and chronic esophagitis. It has a male predominance and dysphagia secondary to esophageal stricture is the most common presenting complaint. Treatment is directed at associated symptomatic conditions and whether or not the diverticula disappear post treatment has no impact on the patients' clinical outcome. Case Description/Methods: This is a case of a 38-year-old male with human immunodeficiency virus (HIV) on anti-retroviral therapy. He was evaluated for a chronic history of dysphagia and odynophagia, associated with nausea, vomiting, heart burn, and weight loss. He underwent EGD which revealed pseudo-diverticula along the entirety of the esophagus with superimposed esophageal candidiasis. Patient was prescribed fluconazole 100 mg oral daily for 2 weeks and will be re-evaluated post treatment (Figure). Discussion: Dysphagia is a common presenting symptom for numerous GI conditions. Though cases of EIPD are uncommon, it is important for clinicians to keep this diagnosis in their differential. The diagnosis of EIPD may not always be apparent through EGD, as the diverticula may be small enough to miss. If a high clinical suspicion remains, radiological imaging with contrast should be considered as it has enhanced sensitivity for detecting these smaller diverticula. EIPD has been associated with Candidiasis, however it is uncertain whether it causes or is a result of the infection. In our case, we were unable to confirm whether EIPD was the cause or result of a Candida infection. Additionally, patient education is important when it comes to dysphagia. Our patient had been experiencing symptoms for 6-7 months before a diagnosis was made. It is important to educate patients that dysphagia is an abnormal symptom and should be further evaluated to determine causal etiology. There is scarce literature available regarding discussion of EIPD, therefore clinicians should continue to report cases to improve our understanding of this rare pathology.Figure 1.: Esophagogastroduodenoscopy images demonstrating esophageal intramural diverticula indicated by yellow arrows, and showing generalized esophageal candidiasis plaques present throughout the entirety of the esophagus.

S2447 “Outpouchings in the Esophagus”: A Rare Case of HIV-Associated Esophageal Intramural Pseudodiverticulosis in the Absence of Esophageal Candidiasis

S2447 “Outpouchings in the Esophagus”: A Rare Case of HIV-Associated Esophageal Intramural Pseudodiverticulosis in the Absence of Esophageal Candidiasis

Oesophageal intramural pseudodiverticulosis, a condition to be aware of

Oesophageal intramural pseudodiverticulosis, a condition to be aware of

Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition characterized by outpouchings from the esophageal lumen into the outer esophageal wall. It can lead to complications such as esophageal strictures presenting as dysphagia and esophagobronchial fistula (EBF) presenting as recurrent aspiration pneumonia. Only 1 other report of EIP with EBF has been reported in the literature. EIP itself is typically managed medically while a complication such as EBF, on the other hand, elicits far more invasive approaches in the form of open surgical intervention. We present the case of a 50 year-old male newly diagnosed with EIP complicated by EBF who was palliated with esophageal stenting. Upper endoscopy with esophageal stent placement offers a safe, feasible, and non-operative therapy for EIP and EBF.

S2143 A Rare Case of Esophageal Intramural Pseudodiverticulosis Complicated With Impaction and Esophageal Abscess

S2143 A Rare Case of Esophageal Intramural Pseudodiverticulosis Complicated With Impaction and Esophageal Abscess

S2085 A Case of Esophageal Intramural Pseudodiverticulosis in Patient With Uncontrolled HIV

S2085 A Case of Esophageal Intramural Pseudodiverticulosis in Patient With Uncontrolled HIV

S1965 Progression of Esophageal Intramural Pseudodiverticulosis in the Setting of Candida

INTRODUCTION: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder characterized by the appearance of multiple small flask-shaped lesions of the esophageal wall. Inflammation of the submucosal glands can cause fibrosis and eventual stricture formation. Here we review a case of EIPD due to recurrent candida esophagitis complicated by esophageal lumenal narrowing. CASE DESCRIPTION/METHODS: The patient is a 48 year old woman who was admitted for hematemesis. She has a complicated medical history of untreated hepatitis C, HIV/AIDS, thrombocytopenia secondary to HIV, recurrent esophageal candidiasis, severe esophagitis and gastritis. She had a history of noncompliance with medications. On admission she had a hemoglobin 4.4, MCV 67.9, platelets 8, WBC 6.7. She received appropriate transfusions and underwent endoscopy. Diffuse white plaques were seen throughout the esophagus along with severe esophagitis (Figure 1), and a benign appearing intrinsic stricture was found at 16cm from the incisors measuring 9 mm in diameter which required downsizing of scope to traverse. This stricture was dilated up to 36Fr. Esophageal biopsies were consistent with Candida esophagitis. Repeat endoscopy for re-treatment was completed 2 days later and diffuse severe mucosal changes consistent with pseudo-diverticulosis were found (Figure 2). The esophageal stricture (Figure 3) was found again and dilation was performed to 45Fr. She completed a 1 month course of fluconazole. Repeat endoscopy one month later showed candida esophagitis and EIPD, but resolution of stenosis. DISCUSSION: Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition with unclear etiology and pathogenesis, although some theorize that chronic inflammation or motility issues may contribute. It has been associated with diabetes mellitus, HIV, alcoholism, gastroesophageal reflux, candidiasis, infectious esophagitis, achalasia, and other motor disorders. Diagnosis is often made during endoscopy or found on imaging such as barium esophageal studies. Stricture development particularly in upper or mid esophagus can occur in up to 50% of patients. Risk of squamous cell carcinoma has also been reported. Conservative management is the treatment of choice, although endoscopic therapy with bougienage dilation is sometimes required, often with repeat dilation. This case highlights a common complication in an uncommon condition. This patient required repeat bougienage dilation, but it is important to remember treatment of underlying etiology is key.Figure 1.: Esophagus with diffuse white plaques of Candida.Figure 2.: Esophagus showing multiple diverticuli of EIPD.Figure 3.: Esophagus with numerous psuedodiverticuli and stricture with EIPD.

S2009 Esophageal Intramural Pseudodiverticulosis and Candidiasis, Which Came First?

INTRODUCTION: Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition resulting from dilatation of excretory ducts of the esophageal deep mucosal glands. Asymptomatic by itself, symptoms are secondary to associated conditions such as gastroesophageal reflux, strictures, esophageal candidiasis and chronic esophagitis. Treatment is directed at the co-existing conditions which result in symptomatic improvement. We report two cases of EIPD with associated esophageal candidiasis. CASE DESCRIPTION/METHODS: A 55-year-old female with medical history significant for HIV underwent EGD for follow up of previous history of esophagitis. Diffuse white plaques characteristic of candida infection with multiple pseudodivertuli were seen in the distal esophagus (Figure 1). Biopsy and special stains were positive for candida hyphae. A 61-year-old female with HCV (not treated) and HIV underwent EGD for suspected upper GI bleeding. Findings included multiple pseudo-diverticuli in mid and distal esophagus (Figure 2) without gross evidence of fungal infection. Biopsy was positive for Candida. DISCUSSION: First described by Mendl in 1960, EIPD has been reported in multiple case reports. EIPD is characterized by numerous small flask shaped outpouchings within the esophageal wall seen on endoscopy. Histology shows squamous, lined, dilated excretory ducts of deep mucous esophageal glands, often surrounded by chronic inflammation. The distribution of the pseudodiverticulosis is variable with 60% of patients reporting diffuse and rest segmental (upper 14%, middle 14%, and lower 12%) distribution. The majority of patients present with intermittent or progressive dysphagia with associated stricture formation. Patients presenting with esophageal stricture require endoscopic dilation for symptom relief. Rare complications including fistula formation, perforation and mediastinitis have been reported. Acute presentations with food impactions although rare have been reported in literature. Apart from direct visualization, the pseudodiverticuli can also be identified on barium esophagogram and computed tomography. EIPD with Candidiasis has been reported approximately in 50% of patients. Despite this high rate of association it is unclear whether Candida has any role in the formation of the pseudodiverticuli. Treatment with anti-fungal therapy has been recommended even in patients with severe obstructive disease. Symptoms resolve but the persistence of pseudodiverticulosis has been reported.Figure 1Figure 2

S2011 Esophageal Intramural Pseudodiverticulin Masquerading as an Esophageal Mass

INTRODUCTION: Esophageal Intramural Pseudodiverticulosis (EIP) is a benign condition of the esophagus. With an estimated 250 reported cases in the literature, it is an exceedingly rare pathology that is characterized by multiple small, flask shaped outpouchings in the esophageal wall. Here we present a rare case of an Esophageal Pseudodiverticulin masquerading as an esophageal mass on imaging. CASE DESCRIPTION/METHODS: The patient is a 53-year-old male with medical history of Acquired Immunodeficiency Syndrome, Pulmonary Embolism, Alcohol use and Seizures who presented to the emergency department (ED) complaining of severe sudden onset abdominal pain, epigastric, radiating to the chest. Additionally, the patient complained of 1 week of nausea, accompanied by 3 episodes of coffee ground emesis and diarrhea. Of note the patient was seen in ED with similar complaints 1 month prior. At that time a computed tomography scan of the abdomen was done which showed a moderate sized hiatal hernia and mass like lesion of the lower esophagus suspicious for acute esophagitis or malignancy (Figure 1). On the current presentation the patient was hemodynamically stable and afebrile. Notable laboratory workup included a hemoglobin of 13.1 gm/dL, a Lipase of 99 U/L, and a negative fecal occult blood test. The patient was then admitted to the medical ward under the impression of acute pancreatitis. The gastroenterology service was then consulted and performed an esophagogastroduodenoscopy (EGD) which showed non-bleeding diverticulosis in the upper and lower esophagus (a large double diverticulum was noted in the lower third) (Figure 2). This finding corresponded to the esophageal thickening that was noted on CT scan suspicious for malignancy. During his hospital course the patient was treated with Pantoprazole, Morphine, and Ondansetron. Despite this treatment the patient decided to leave the hospital against medical advice. DISCUSSION: Although its pathogenesis remains unclear EIP has been associated with chronic inflammatory conditions such as diabetes mellitus, esophageal candidiasis, alcohol consumption, achalasia, and GERD. It most commonly causes progressive dysphagia, odynophagia and chest tightness. The treatment of EIP is aimed at palliating symptoms and treating underlying predisposing conditions. Mechanical endoscopic dilation has shown success when EIP is associated with an esophageal stricture. In these cases, pseudodiverticla may be reduced or disappear entirely after dilation.Figure 1.: CT of the chest showing esophageal wall thickening concerning for malignancy (blue arrow).Figure 2.: Esophagogastroduodenscopy demonstrating esophageal intramural pseudodiverticulosis.

S1900 Esophageal Pseudodiverticulosis Mimicking Esophageal Perforation

INTRODUCTION: Esophageal intramural pseudodiverticulosis (EIP) is a rare benign pathology, It is attributed to the defective secretion of submucosal glands followed by the abnormal dilation of ducts and development of pseudodiverticular outpouchings. It commonly presents as dysphagia. Here we report an unusual presentation of EIP with retrosternal chest pain, mimicking esophageal perforation. CASE DESCRIPTION/METHODS: A 53-year-old female with a past medical history of COPD, hypertension, depression, and anxiety disorder was brought to the hospital from another facility with a 5-day history of retrosternal chest pain radiating to the back and mild shortness of breath. The patient complained of a 3-month history of pain on swallowing both for liquids and solids. There was a history of poor oral intake and weight loss of 5 pounds in the last 1 month. She has a long term underlying acid reflux and was not on any medications. The physical exam was within normal limits. Lab investigations including CBC and CMP were normal. CT chest showed some 2.5 cm × 2.6 cm × 8 cm lesions in the subcarinal area in the posterior mediastinum along the esophageal wall. There were some air pockets concerning possible esophageal perforation. Esopharogram was performed which showed no perforation. Esophagogastroduodenoscopy (EGD) was performed which showed candida esophagitis with the presence of multiple esophageal pseudodiverticulosis. A repeat CT chest did not reveal any esophageal mass. There was likely esophageal thickening related to Candida esophagitis with associated multiple esophageal pseudodiverticulosis. The patient was started on fluconazole with a plan of repeat EDG in 4 weeks after completing antifungal treatment. DISCUSSION: Dysphagia is considered to be a common presenting symptom in EIP. It is frequently associated with certain inflammatory and infective etiologies including esophagitis, diabetes mellitus, and gastroesophageal reflux disease. Endoscopy is considered to be the initial diagnostic test. Other investigations involving CT, esophageal contrast radiography, and histology are also performed for confirming the diagnosis. The treatment includes the management of underlying pathology. In most of the cases, strictures are formed and endoscopic dilation can alleviate the symptoms of such patients.Figure 1.: Transmural severe thickening of esophageal wall with a tiny air pocket mimicking possible micro-perforation.Figure 2.: Multiple tiny projections arising from esophageal wall consistent with esophageal pseudodiverticulosis.Figure 3.: Mutiple tiny diverticuli with submucosal bulge. Mild luminal stenosis with esophageal candidiasis.

Esophageal Intramural Pseudodiverticulosis Related to Candidiasis

A 44-year-old Hispanic man with human immunodeficiency virus (CD4 count 270/mm) presented with 1 week of solid dysphagia. Upper endoscopy revealed white plaques in the proximal esophagus (Figure A) with few mucosal defects in the proximal and mid esophagus indicative of diverticulosis (Figures B–D). These findings were consistent with a diagnosis of esophageal intramural pseudodiverticulosis. No esophageal stricture was noted. Esophageal brushings revealed fungal organisms consistent with Candida.

A rare cause of dysphagia due to esophageal intramural pseudodiverticulosis: a case report and review of literature

BackgroundEsophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options.Case presentationIn this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement.ConclusionsThis case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.