Esophageal intramural pseudodiverticulosis - Review of symptoms including upper gastrointestinal bleeding

Background: Esophageal intramural pseudodiverticulosis (EIP) is a rare cond ition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous gla nds. Study: Five patients with EIP were evaluated with regard to symptoms a nd 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 endoscopi cally in all cases. Endoscopic findings other than pseudodiverticula were e sophageal webs (n = 2) and proximal esophageal stenoses (n = 4). The typica l radiologic findings were detectable in two patients, pathologic manometri c findings were seen in only one patient. The authors treated the concomita nt diseases and performed endoscopic dilatations of esophageal stenoses. On e 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 pseudodiverticulosi s is a differential diagnosis in cases of dysphagia and/or esophageal stric tures if no other causes are found. The authors think that endoscopy is the method of choice for establishing the diagnosis.