Esophageal intramural pseudodiverticulosis

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Esophageal intramural pseudodiverticulosis
Other namesEIPD
Proton-pump inhibitors

Esophageal intramucosal pseudodiverticulosis (EIPD) is a rare condition wherein the wall of the

dilation
of strictures in the esophagus.

Signs and symptoms

As the condition involves alterations in the wall of the esophagus and reduction in the calibre of the esophagus, the symptoms of esophageal intramucosal pseudodiverticulosis are primarily related to swallowing. Difficulty swallowing solids[1] and pain while swallowing (odynophagia) are common symptoms.[2] In extreme cases, food may become impacted in the esophagus.[3] Some individuals may have bleeding in the esophagus, manifesting as vomiting of blood or as melena stools.[1] With the reduction of oral intake due to difficulty swallowing, affected individuals usually lose weight.[4]

Cause

The cause of esophageal intramucosal pseudodiverticulosis is uncertain. It has been hypothesized that the pseudodiverticulae are not a primary phenomenon, but rather are secondary to a chronic irritant to the esophagus, or to accentuation in the

diabetes mellitus, and gastroesophageal reflux disease.[1]

Diagnosis

Esophageal intramucosal pseudodiverticulosis is typically diagnosed at the time of

mucosal lining of the esophagus may be inflamed, and this can be seen on endoscopy or on biopsy; the mucosa, however, may also be normal if esophagitis is not the cause of the pseudodiverticulosis. The condition must also be excluded from esophageal cancer, which may be done at the time of endoscopy, or which may require esophageal biopsy.[3]

Pseudodiverticulae may also be seen on

barium swallow imaging of the esophagus. The appearance is of flask-shaped pseudodiverticulae, which may be present in the entire esophagus diffusely, or may be segmental. The pseudodiverticulae may be seen preferentially in the lower esophagus on barium swallow also. Strictures or narrowings in the esophagus may also be seen, typically in the upper esophagus.[5][6]

As esophageal intramucosal pseudodiverticulosis is also associated with motility disturbances of the esophagus, manometry testing of esophageal pressures may provide information to assist in the diagnosis. Irregularity in the contractions of the esophagus, prominent tertiary contractions of the esophagus, or lack of esophageal contraction (aperistalsis) have all been reported on manometric testing of the esophagus.[7]

Management

Several treatment regimens have been described for esophageal intramucosal pseudodiverticulosis. Because the condition is associated with

esophageal bougies may provide relief of swallowing symptoms.[3]
The pseudodiverticulae themselves rarely cause symptoms, and treatment is not directed toward them.

Prognosis

Periodic surveillance of the esophagus with endoscopy has been recommended due to a reported association of the condition with esophageal cancer. Rarely a condition called peridiverticulitis, associated with inflammation around the pseudodiverticulae has been reported over time leading to chest pain or pain while swallowing.[3][8]

Epidemiology

Approximately 250 cases of esophageal intramucosal pseudodiverticulosis have been reported.

barium swallow x-rays identified the condition in 0.15% of individuals who had the procedure.[5] While the disease has been reported as occurring at any time during life, it most frequently affects individuals in their 50s and 60s.[3]

References

  1. ^
    S2CID 13623816
    .
  2. ^
    PMID 32162106
    .
  3. ^
    PMID 16432558
    .
  4. S2CID 44798585
    .
  5. ^
    PMID 3096096
    .
  6. ^
    PMID 16388181
    .
  7. PMID 3934782
    .
  8. PMID 7484570
    .
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