Reid Wasserman, DO
Gastroenterology Fellow, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
Klaus Mönkemüller, MD, PhD, FASGE, FESGE, FJGES
Professor of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
Esophageal intramural pseudodiverticulosis (EIP) is an uncommon, benign condition characterized by multiple tiny, flask-shaped openings (in barium esophagogram – outpouchings) (tiny diverticula) within the wall of the esophagus (1). These “pseudodiverticula” are actually dilated excretory ducts of the esophageal submucosal glands rather than true protrusions or diverticula of the mucosal layer through the muscle wall.
The condition involves the cystic dilation of submucosal gland ducts, often associated with chronic inflammation and periductal fibrosis. Most commonly diagnosed in the 6th and 7th decades of life, with a slight predilection for males. It is extremely rare, found in approximately 0.15% of barium swallow examinations (1, 2).
The outpouchings can be diffuse (60%) or segmental (40%). Segmental cases often occur in the upper esophagus, while recent studies also link mid-to-distal involvement with conditions like eosinophilic esophagitis (EoE). EIP is associated with GERD, DM, chronic alcoholsm, tobacco use and esophageal dysmotility disorders (1-3).
Treatment is focused on the primary conditions. If the patient has associated stenosis dilation may be necessary (3).
References:
1. Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol. 2024 Jan 14;30(2):137-145. doi: 10.3748/wjg.v30.i2.137. PMID: 38312118; PMCID: PMC10835521.
2. Hahne M, Schilling D, Arnold JC, Riemann JF. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol. 2001 Nov-Dec;33(5):378-82. doi: 10.1097/00004836-200111000-00007. PMID: 11606853.
3. Hahne M, Schilling D, Arnold JC, Riemann JF. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol. 2001 Nov-Dec;33(5):378-82. doi: 10.1097/00004836-200111000-00007. PMID: 11606853.
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