Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review

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.

Zusammenfassung

Hintergrund Die intramurale Pseudodivertikulose der Speiseröhre (EIPD) ist eine seltene Erkrankung, die zu Dysphagie, Brustschmerzen und Gewichtsverlust führen kann. Die Diagnose ist schwierig und kann mit einer eosinophilen Ösophagitis (EoE) verwechselt werden. Wir stellen eine Patientin mit ösophagealer intramuraler Pseudodivertikulose und eine Literaturübersicht vor.

Fallbericht Eine 45-jährige weiße Frau mit chronischem Nikotin- und Alkoholabusus klagte über progrediente Heiserkeit und Dysphagie für feste Nahrung. Die Ösophagogastroduodenoskopie (ÖGD) zeigte eine proximale Ösophagusstenose, Soorösophagitis und den Verdacht einer EoE mit Mukosaveränderungen und Trachealisierung. Nach mehrmaligen Bougierungen ergaben die ÖGD und der Bariumschluck die typischen Zeichen einer EIPD. Die Patientin erhielt mehrmalige Ösophagusbougierungen, eine Säurehemmung und antimykotische Therapie. Die Literatur-Analyse zeigt die Charakteristika der EIPD bezüglich Alter, Geschlecht, Risikofaktoren und Therapiemöglichkeiten.

Schlussfolgerung Die Ergebnisse und die Literaturübersicht zeigen, dass EIPD und EoE verwechselt werden können.

Key words

dysphagia - regurgitation - noncardiac chest pain - esophageal intramural pseudodiverticulosis - eosinophilic esophagitis

Schlüsselwörter

dysphagie - regurgitation - nichtkardialer Brustschmerz - intramurale Pseudodivertikulose der Speiseröhre - eosinophile Ösophagitis

Publikationsverlauf

Eingereicht: 17. Mai 2020

Angenommen: 06. Oktober 2020

Artikel online veröffentlicht:
05. November 2020

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