Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding.

Background: Esophageal intramural pseudodiverticulosis (EIP) is a rare condition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous glands.

Study: Five patients with EIP were evaluated with regard to symptoms and concomitant diseases, as well as endoscopic, radiologic, and manometric findings.

Results: Primary clinical symptoms reported by the five patients (three men and two women; age range, 59-72 years) were increasing dysphagia ( n = 3), upper gastrointestinal bleeding ( n = 1), and no symptoms ( n = 1). Concomitant diseases were chronic alcoholism ( n = 3), diabetes mellitus ( n = 1), and reflux esophagitis ( n = 1). Primary diagnosis was made endoscopically in all cases. Endoscopic findings other than pseudodiverticula were esophageal webs ( n = 2) and proximal esophageal stenoses ( n = 4). The typical radiologic findings were detectable in two patients, pathologic manometric findings were seen in only one patient. The authors treated the concomitant diseases and performed endoscopic dilatations of esophageal stenoses. One case with initial bleeding from an associated web is described in detail. According to our knowledge, this is the first publication of a case of EIP-associated bleeding.

Conclusion: Esophageal intramural pseudodiverticulosis is a differential diagnosis in cases of dysphagia and/or esophageal strictures if no other causes are found. The authors think that endoscopy is the method of choice for establishing the diagnosis.