Esophageal intramural pseudodiverticulosis

Abstract

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.

Esophagobronchial Fistula Resulting from Esophageal Intramural Pseudodiverticulosis

“…Others have proposed that the presence of submucosal glands in excessive numbers results in recurrent or chronic inflammation and cystic dilatation with hyper plastic and metaplastic changes occurring within the cyst walls [2]. Some autopsy studies, however, have corrobo rated the proposition that the pseudodiverticulae repre sent dilatations of excretory ducts of the normal submu cosal glands of the esophagus [3][4][5]. In these studies, the submucosal glands did not participate in the formation of the pseudodiverticulae and they were not increased in number.…”

A Case of Esophageal Intramural Pseudodiverticulosis

“…Histologically, pathologically dilated submucosal glands and excretory ducts were detected. [4][5][6][7] Considering the presence of inflammatory cells around excretory ducts, it has been suggested that the ducts were obstructed by inflammation of epithelial cells or mucus around the ducts. 4,5 On the contrary, others asserted submucosal fibrosis caused by chronic irritation had resulted in the obstruction of the ductal orifices.…”

Esophageal Intramural Pseudodiverticulosis

“…This suggested the conditions predispos ing to EIPD development and the condition itself may be more common than previously thought. There appears to be a slight male pre dominance (male:female ratio 1.4:1) [4,5]; the age ranges from 1 to 86 years, 56% of the patients being in their 7th and 8th decades of life. There may be a predominance among …”

“…Motility studies are usually done in the context of the dysphagia evalua tion. Disturbances have been noted in ap proximately 77% of the patients [4], There is no characteristic pattern of motility as the entire spectrum from aperistalsis to prolonged high-amplitude contractions has been de scribed [4,9]. As many patients have diabetes mellitus, an autonomic neuropathy is postu lated.…”

“…The depth to which they extend corresponds to the thickness of the surrounding esophageal wall. The out pouchings are distributed throughout the en tire esophageal length in two thirds of the patients [4], An esophageal stricture is present in as many as 90% of EIPD patients [9], 50% located in the upper two thirds of the esopha gus. In contrast, the strictures formed by chronic gastroesophageal reflux are usually more distal, being located in the lower half of the esophagus.…”