Esophageal Intramural Pseudodiverticulosis Research Articles

Esophageal Intramural Pseudodiverticulosis Treated by Balloon Dilatation: Report of a Case

A 72-year-old man presented with a 17-year history of dysphagia, which had gradually become worse in recent months. A barium esophagogram showed stenosis of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings along the region of stenosis. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis. He underwent successful balloon dilatation of the stenosis and his dysphagia resolved. Dynamic esophagography showed improved passage through the esophagus. He has been well and not suffering from dysphagia for 4 years since the balloon dilatation.

A rare cause of dysphagia

Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon cause of dysphagia. In this report, we describe two cases we encountered at autopsy. In both cases, the pseudodiverticula represented dilated excretory ducts of submucosal mucous glands. In addition, we retrospectively examined histologic sections of esophagus taken randomly from 100 autopsies, and prospectively studied 20 esophagi in a standardized fashion. Our findings suggest that the early pathologic changes of EIPD are more common than is appreciated in the literature. We found submucosal chronic inflammation surrounding mucous glands in more than 60% of esophagi at autopsy. Excretory duct dilatation and small pseudodiverticula were also commonly found, their prevalence related to the number of sections of esophagus studied. The finding of chronic inflammation associated with the earliest degrees of duct dilatation and pseudodiverticula formation suggests that inflammation may play a role in the etiology of this disorder.

Radiologic diagnosis of benign esophageal strictures: a pattern approach.

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

Esophageal Intramural Pseudodiverticulosis.

Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon esophageal abnormality that is best diagnosed with a barium esophagram. The disorder is usually associated with other esophageal pathology, including strictures, motility disturbances, and other conditions that are outlined later. There is no specific treatment (either surgical or medical) for EIPD itself, and treatment should be directed at the underlying, associated conditions. If this condition is diagnosed on a barium study, endoscopy usually is needed to treat an associated stricture or to diagnose an associated inflammatory condition (particularly acid reflux and esophageal infections). Thus, endoscopy and barium studies are critical to guide the management of this condition.

Clinical and endoscopic features of patients with esophageal intramural pseudodiverticulosis. (EIP)

Clinical and endoscopic features of patients with esophageal intramural pseudodiverticulosis. (EIP)

A case of esophageal intramural pseudodiverticulosis

A 62-year-old man had a medical examination on our hospital on March 7, 2000. He had complained of dysphagia for a year. Esophagogram revealed multiple flask-shaped outpouchings in the upper intrathoratic esophagus, then he was diagnosed as esophageal intramural pseudodiverticulosis (EIPD) . Esophagoscopy on April 10, 2000, showed multiple white plaques and mild stenosis in the upper intrathoratic esophagus. Histological examination demonstrated inflammatory cells which massively infiltrated into the epithelium, and presence of Candida Albicans. Therefore, he was diagnosed as EIPD with Candida esophagitis. After antifungal medications were administered for a week, dysphagia was improved. Esophagoscopy on May 9, 2000, revealed multiple orifices of the pseudodiverticula. We reviewed Esophagogram from another hospital, then we found that EIPD had grown up for a year.

Esophageal intramural pseudodiverticulosis-associated with severe iron deficiency anemia

Purpose: Esophageal intramural pseudodiverticulosis is a rare condition. Although this is strongly associated with gastroesophageal reflux disease, hiatal hernia and esophageal strictures, severe iron deficiency anaemia secondary to esophageal intramural esophageal diverticulosis has not been reported previously.

Intramural tracking: a feature of esophageal intramural pseudodiverticulosis.

Our purpose was to determine the frequency of intramural tracking in patients with esophageal intramural pseudodiverticulosis and to characterize the morphologic features of this finding on barium studies. A review of radiology files at two institutions revealed 30 cases of esophageal intramural pseudodiverticulosis diagnosed at esophagography. In all cases, the radiographs were reviewed retrospectively to determine the frequency and morphologic features of intramural tracking in these patients. The number and distribution of pseudodiverticula and the presence or absence of strictures or esophagitis were also noted. Fifteen (50%) of 30 patients with esophageal intramural pseudodiverticulosis had intramural tracking on esophagography. The tracks had an average length of 1.2 cm (length range, 0.3-7 cm) and an average width of 1.6 mm (width range, 1-4 mm). The pseudodiverticula were more numerous and had a more diffuse distribution in patients with tracking than in patients without tracking. Although patients with and without tracking had a similar frequency of strictures and esophagitis, patients with tracking were more likely to have strictures involving the upper or mid esophagus, whereas patients without tracking were more likely to have strictures in the distal esophagus. These findings indicate that intramural tracking is more likely to occur in patients with the diffuse form of esophageal intramural pseudodiverticulosis. Intramural tracking was detected on esophagography in 50% of patients with esophageal intramural pseudodiverticulosis, so this type of tracking is a more common radiographic finding than has previously been recognized. Although intramural tracking has little or no known clinical significance, it is important to be aware of this finding so that it is not mistaken for a large flat ulcer in the esophagus or for an extramural collection associated with esophageal peridiverticulitis.

Esophageal intramural pseudodiverticulosis associated with a web in a 12-year-old boy

Esophageal intramural pseudodiverticulosis (EIPD) is a rare benign disorder characterized by dilation of the submucosal glands. Its etiology and pathogenesis are largely unknown. So far, less than 10 pediatric cases of EIPD have been reported. The authors present the case of a 12-year-old boy with EIPD that was associated with a cervical esophageal web. He was treated successfully with dilation therapy.

A case of esophageal intramural pseudodiverticulosis complicated with primary biliary cirrhosis and mixed connective tissue disease

A case of esophageal intramural pseudodiverticulosis complicated with primary biliary cirrhosis and mixed connective tissue disease

Duodenal intramural pseudodiverticulosis

Although esophageal intramural pseudodiverticulosis is well described, similar pathology has not been demonstrated elsewhere in the gastrointestinal tract. Three cases are reported with identical changes in the duodenum, one of which had simultaneous esophageal involvement. All three patients were alcohol abusers.

Corrosive Acid-Induced Esophageal Intramural Pseudodiverticulosis A Study of 14 Patients

Esophageal intramural pseudodiverticulosis (EIP) is a rare disease, characterized by multiple, small flask-shaped diverticula in the esophageal wall, and best demonstrated on single-contrast barium examination. Though the condition is often associated with reflux esophagitis, Candida esophagitis, and esophageal dysmotility, corrosive-acid injury is not a commonly recognized cause. In a radiological study involving 59 patients with sequelae of corrosive-acid injury of the upper gastrointestinal (GI) tract, evaluated over a 5-year period, 14 cases (23.7%) of EIP were found. Esophageal stricture was a constant association; the diverticula tended to involve either the entire length of the stricture or its upper part. There was, however, no correlation between the length of the stricture and number of diverticula (p greater than 0.05). Endoscopic dilatation resulted in relief of dysphagia, and the diverticula regressed in number of disappeared altogether. Our experience suggests that EIP is a common sequelae of esophageal acid injuries, and that diverticula tend to form at the site of initial contact between acid and susceptible esophageal mucosa. Stricture dilatation leads to reduction or total disappearance of the diverticula.

Oesophageal intramural pseudodiverticulosis—always benign?

Oesophageal intramural pseudodiverticulosis is a rare condition that presents with dysphagia. The diagnosis is usually not apparent endoscopically and careful radiological evaluation is required. Previous reports suggest a benign course with good response of dysphagia to oesophageal dilatation and complications have not been described. Two cases are reported, one in whom life threatening haemorrhage developed following dilatation, and one complicated by a retro-oesophageal collection. It is possible that oesophageal intramural pseudodiverticulosis results in an increased propensity to trauma and even perforation.

Oesophageal intramural pseudodiverticulosis

AbstractA case of oesophageal intramural pseudodiverticulosis is presented and the clinical, pathological and specific radiological features are documented.

Diffuse esophageal intramural pseudodiverticulosis and nutcracker esophagus in a 54-year-old man

Esophageal intramural pseudodiverticulosis, which was first described by Mendl et al. in 1960, is characterized by multiple small flask-shaped outpouchings in the esophageal wall. The pseudodiverticula represent dilated excretory ducts of deep mucous glands in the esophagus. The etiology of this rare condition is unknown. Hiatal hernias, gastroesophageal reflux, esophageal strictures, candida esophagitis, herpes esophagitis, diabetes mellitus, and chronic alcoholism have been found associated with intramural pseudodiverticulosis. We report the second case of esophageal hypermotility in intramural pseudodiverticulosis.

Esophageal intramural pseudodiverticulosis: A report of two cases with analysis of similar, less extensive changes in “normal” autopsy esophagi

Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon cause of dysphagia. In this report, we describe two cases we encountered at autopsy. In both cases, the pseudodiverticula represented dilated excretory ducts of submucosal mucous glands. In addition, we retrospectively examined histologic sections of esophagus taken randomly from 100 autopsies, and prospectively studied 20 esophagi in a standardized fashion. Our findings suggest that the early pathologic changes of EIPD are more common than is appreciated in the literature. We found submucosal chronic inflammation surrounding mucous glands in more than 60% of esophagi at autopsy. Excretory duct dilatation and small pseudodiverticula were also commonly found, their prevalence related to the number of sections of esophagus studied. The finding of chronic inflammation associated with the earliest degrees of duct dilatation and pseudodiverticula formation suggests that inflammation may play a role in the etiology of this disorder.

Esophageal intramural pseudodiverticulosis: a reevaluation

Esophageal intramural pseudodiverticulosis is an unusual condition manifested by tiny flask-shaped outpouchings in the wall of the esophagus. The condition was diagnosed in 21 (0.15%) of 14,350 patients undergoing radiologic examinations of the esophagus at our hospitals. The pseudodiverticula were detected only by single-contrast technique in five of 18 patients (28%) who underwent both single- and double-contrast examinations. Thus, thin, low-density barium seems to enter these structures more readily than the high-density barium used for double-contrast esophagography. While most patients reported in the literature have diffuse or segmental pseudodiverticulosis associated with high esophageal strictures, the majority of our patients (11 [52%] of 21) had isolated involvement of the distal esophagus with 10 or fewer pseudodiverticula in the region of a peptic stricture. Other associated conditions included Candida esophagitis, herpes esophagitis, and squamous cell carcinoma of the esophagus. Our experience suggests that pseudodiverticulosis usually represents a sequela of reflux esophagitis, although the reason that so few patients with esophagitis develop this condition is unclear.

Intramural pseudodiverticulosis of the esophagus

Two cases of esophageal intramural pseudodiverticulosis are presented. A brief review is made of previously published reports. This entity, first described in 1960, is still rarely diagnosed. Its etiology is still debatable. However, as more cases are published, it becomes more apparent that esophageal intramural pseudodiverticula can be found as part of a distinct syndrome with diffuse intramural pseudodiverticulosis, as originally described by Mendl, or localized in a limited extension of the esophagus as a response to esophageal obstruction.

Chronic mucocutaneous candidiasis: radiologic abnormalities in the esophagus

Chronic mucocutaneous candidiasis is a disorder characterized by chronic recurrent infection with Candida. The esophagus may be involved, resulting in chronic candidal esophagitis, which is clinically and radiographically distinct from acute candidal esophagitis. The clinical and radiographic features of four new and four previously reported cases are presented. Esopahgeal narrowing was found in all patients; it was focal in six and diffuse in two. Motor abnormalities were common, but mucosal changes seen characteristically in acute candidal esophagitis were unusual. Esophageal intramural pseudodiverticulosis was documented in one patient, substantiating the belief that Candida may be the etiologic agent in some patients with this condition.

Esophageal intramural pseudodiverticulosis

Three cases of esophageal intramural pseudodiverticulosis (EIP) are described and the literature reviewed. We conclude that EIP is an inflammatory disease of unknown etiology characterized by dilatation of the esophageal submucosal glandular elements. The classic radiographic picture which is that of collar-button-shaped outpouchings projecting in a perpendicular fashion from the luminal surface is mainly related to dilatation in the glandular ductal system. It is usually diagnosed in the sixth and seventh decades, but all ages may be affected. Dysphagia is a very common but not universal symptom of the disease process. Approximately one third of these patients have diabetes mellitus. Strictures of the esophagus are frequently seen, and varying degrees of esophagitis may be manifest endoscopically. Esophageal motility disturbances are common and may be severe. Candida infestation with and without tissue invasion has been seen in a number of patients and should be searched for in all cases of EIP.