Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.
Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
BMC Gastroenterol. 2020 Mar 16;20(1):72. doi: 10.1186/s12876-020-01209-y.
Esophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options.
In this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement.
This case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.
食管壁内假性憩室病是一种罕见的、特发性疾病，其特征为食管腔多个小的突出的假性憩室。食管壁内假性憩室病与胃食管反流病、糖尿病等疾病有关，还会并发气胸等紧急并发症。最常见的表现症状是伴有食管狭窄的吞咽困难。虽然 EIP 的发病机制尚未确定，但重要的是要认识到这种具有独特诊断结果和治疗选择的疾病。
本例为一名 62 岁女性，在被诊断为食管壁内假性憩室病、严重狭窄之前，曾有多年的吞咽困难、无法耐受常规饮食和非自愿性体重减轻病史。食管造影和食管胃十二指肠镜检查诊断为食管壁内假性憩室病，并发严重狭窄。在接受序贯扩张和维持 H2 阻滞剂治疗后，她的症状显著改善。
本例强调了准确识别和治疗罕见的吞咽困难原因——食管壁内假性憩室病的重要性。治疗包括扩张治疗，正如我们的患者所展示的那样。此外，治疗重点是优化医学管理，如我们的患者在 GERD 中添加 H2 阻滞剂，或通过手术解决潜在的严重潜在原因，如癌症。
