Concomitant esophageal intramural pseudodiverticulosis and eosinophilic esophagitis: a diagnosis that needs to be histologically proved

Abstract Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review. Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities. Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.

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Esophageal Intramural Pseudodiverticulosis and Concomitant Eosinophilic Esophagitis: A Case Series

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/1761874 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Michael A. Scaffidi ◽

Ankit Garg ◽

Brandon Ro ◽

Christopher Wang ◽

Tony T. C. Yang ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Case Series ◽

Clinical Information ◽

Esophageal Wall ◽

Food Bolus ◽

First Case ◽

Academic Center ◽

Potential Association ◽

Esophageal Intramural Pseudodiverticulosis ◽

Characteristic Features

Background. Esophageal intramural pseudodiverticulosis (EIPD) is an idiopathic benign chronic disease characterized by flask-like outpouchings of the esophageal wall. It is unknown whether there is a genuine association between EIPD and eosinophilic esophagitis (EoE).Aims. To investigate a possible relationship between EIPD and EoE.Methods. Patients with radiographic or endoscopic evidence of pseudodiverticulosis were identified from the database at a single academic center. Cases were analyzed in three areas: clinical information, endoscopic findings, and course.Results. Sixteen cases of esophageal pseudodiverticulosis were identified. Five patients had histologic evidence of eosinophilic esophagitis. Patients with EoE had pseudodiverticula in the mid-to-distal esophagus while those with EIPD had pseudodiverticula predominantly in the proximal esophagus (p<0.001). EoE with pseudodiverticulosis occurred in younger patients (p<0.019). Food bolus obstructions were more common in patients with EoE and pseudodiverticulosis than in EIPD (p<0.034).Conclusions. This is the first case series supporting a potential association between EoE and pseudodiverticulosis. We also identify characteristic features of pseudodiverticulosis that may raise clinical suspicion of underlying eosinophilic esophagitis.

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