Asunto(s)
Trastornos de la Motilidad Esofágica/etiología , Mucosa Esofágica/patología , Estenosis Esofágica/diagnóstico , Reflujo Gastroesofágico/diagnóstico , Inhibidores de la Bomba de Protones/administración & dosificación , Biopsia , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico , Trastornos de la Motilidad Esofágica/diagnóstico , Trastornos de la Motilidad Esofágica/tratamiento farmacológico , Trastornos de la Motilidad Esofágica/patología , Mucosa Esofágica/diagnóstico por imagen , Estenosis Esofágica/tratamiento farmacológico , Estenosis Esofágica/etiología , Estenosis Esofágica/patología , Esofagoscopía , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. METHODS: Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. RESULTS: In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). CONCLUSION: With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.
Asunto(s)
Trastornos de Deglución/etiología , Diverticulosis Esofágica/diagnóstico , Endoscopía del Sistema Digestivo/métodos , Mucosa Esofágica/patología , Inflamación/diagnóstico , Anciano , Alcoholismo/complicaciones , Manejo de Datos , Trastornos de Deglución/epidemiología , Diagnóstico Diferencial , Diverticulosis Esofágica/epidemiología , Diverticulosis Esofágica/patología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Nicotiana/efectos adversosRESUMEN
Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.
Asunto(s)
Candida albicans/aislamiento & purificación , Candidiasis/diagnóstico , Trastornos de Deglución/diagnóstico , Diverticulosis Esofágica/diagnóstico , Anciano , Antifúngicos/administración & dosificación , Candidiasis/tratamiento farmacológico , Trastornos de Deglución/tratamiento farmacológico , Humanos , MasculinoAsunto(s)
Esófago de Barrett/complicaciones , Diverticulosis Esofágica/etiología , Endoscopía Gastrointestinal/métodos , Endosonografía/métodos , Esofagitis Péptica/complicaciones , Úlcera Péptica/complicaciones , Esófago de Barrett/diagnóstico , Diverticulosis Esofágica/diagnóstico , Esofagitis Péptica/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/diagnósticoRESUMEN
Dysphagia is a common complaint of patients seen at the outpatient clinic as well as at the emergency room. We report esophageal intramural pseudodiverticulosis (EIPD) as a cause of dysphagia that is less known by physicians and it is rarely described in the literature. EIPD is characterized by multiple, segmental or diffuse, flask-like outpouchings in the esophageal wall corresponding to dilated and inflamed excretory ducts of the submucosal esophageal glands. The underlying etiology remains unclear. Esophageal strictures, esophageal candidiasis and gastroesophageal reflux disease are often associated. The diagnosis can be made by upper gastrointestinal endoscopy, but barium esophagography is the modality of choice. Complications of EIPD are rare and include broncho-esophageal and esophagomediastinal fistula, pleural and pericardial effusion, abscesses, gastrointestinal bleeding from a web-like stenosis or esophageal perforation with pneumomediastinum. The treatment for EIPD should be directed towards treating underlying associated conditions and relieving symptoms rather than the pseudodiverticulosis itself.
Asunto(s)
Diverticulosis Esofágica/diagnóstico , Perforación del Esófago/diagnóstico por imagen , Estenosis Esofágica/diagnóstico por imagen , Enfisema Mediastínico/diagnóstico por imagen , Trastornos de Deglución/etiología , Diverticulosis Esofágica/complicaciones , Endoscopía del Sistema Digestivo , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/diagnóstico , Perforación del Esófago/complicaciones , Estenosis Esofágica/complicaciones , Humanos , Masculino , Enfisema Mediastínico/etiología , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer (T3N2M0 Stage III) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation, including redness, erosion, edema, bleeding, friability, and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine, gastrografin-filled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly, endoscopic balloon dilatation was performed and anti-fungal therapy was started in the hospital. Seven weeks later, endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently, the patient was discharged. At the latest follow-up, the patient was symptom-free and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.
Asunto(s)
Diverticulosis Esofágica/etiología , Divertículo Esofágico/etiología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Biopsia , Candida glabrata/aislamiento & purificación , Candidiasis/microbiología , Trastornos de Deglución/etiología , Dilatación , Diverticulosis Esofágica/diagnóstico , Diverticulosis Esofágica/microbiología , Diverticulosis Esofágica/terapia , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/microbiología , Divertículo Esofágico/terapia , Neoplasias Esofágicas/patología , Estenosis Esofágica/etiología , Esofagoscopía , Humanos , Masculino , Estadificación de Neoplasias , Factores de Riesgo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We here report a rare case of esophageal intramural pseudodiverticulosis with dysphagia. A 65-year-old man was suffering from intermittent dysphagia for 10 years, which had been worsening in recent months. Endoscopic examination revealed multiple, small, saccular diverticula and mild annular stricture with numerous white plaques from the cervical esophagus to the middle thoracic esophagus. Barium esophagography revealed stricture of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis and inflammation of a narrow segment of the esophagus. Biopsy specimen showed acute and chronic esophagitis with Candida infection. Dysphagia persisted despite resolution of candidiasis, for which we successfully performed endoscopic balloon dilatation of the stricture. After the treatment, the patient has been well and has not been suffering from dysphagia.
Asunto(s)
Dilatación/métodos , Diverticulosis Esofágica/terapia , Endoscopía del Sistema Digestivo/métodos , Anciano , Candidiasis , Enfermedad Crónica , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Progresión de la Enfermedad , Diverticulosis Esofágica/complicaciones , Diverticulosis Esofágica/diagnóstico , Estenosis Esofágica/etiología , Estenosis Esofágica/terapia , Esofagitis/complicaciones , Esofagitis/diagnóstico , Esofagitis/microbiología , Esofagitis/patología , Humanos , Masculino , Resultado del TratamientoRESUMEN
Esophageal intramural pseudodiverticulosis is a rare pathology whose etiology is unknown, but which is frequently associated with three highly prevalent entities: esophageal reflux disease, esophageal candidosis and alcoholic esophagitis. With conservative treatment the course of these pathologies is usually benign. However, some severe cases are resistant to conservative treatment and may require more aggressive management. We here present the case of patient suffering from a severe esophagitis complicated by chronic mediastinitis with life-threatening repercussions, requiring esophagectomy as treatment.
La pseudodiverticulose Åsophagienne intramurale est une pathologie rare, d'étiologie inconnue, mais fréquemment associée à trois entités hautement prévalentes: la maladie de reflux, la candidose Åsophagienne et l'Åsophagite alcoolique. L'évolution de ces pathologies est habituellement bénigne avec un traitement conservateur. Certains cas sévères nécessitent toutefois une prise en charge plus agressive. Nous présentons ici le cas d'un patient souffrant d'une Åsophagite sévère compliquée d'une médiastinite chronique avec des répercussions menaçant sa survie, ayant nécessité une prise en charge chirurgicale agressive.
Asunto(s)
Trastornos de Deglución/etiología , Neoplasias Esofágicas/diagnóstico , Estenosis Esofágica/diagnóstico , Esofagitis/diagnóstico , Candidiasis/diagnóstico , Candidiasis/patología , Candidiasis/cirugía , Enfermedad Crónica , Trastornos de Deglución/patología , Trastornos de Deglución/cirugía , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico , Diverticulosis Esofágica/patología , Diverticulosis Esofágica/cirugía , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Estenosis Esofágica/patología , Estenosis Esofágica/cirugía , Esofagectomía , Esofagitis/patología , Esofagitis/cirugía , Esofagoscopía , Esófago/patología , Humanos , Masculino , Mediastinitis/diagnóstico , Mediastinitis/patología , Mediastinitis/cirugía , Persona de Mediana EdadRESUMEN
UNLABELLED: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder in adults, and even more in infants and children. It is characterized by the dilatation of the submucosal esophageal glands. The exact etiology and pathophysiology of EIPD is, however, unknown. Dysphagia is the predominant presenting symptom in both children and adults. CONCLUSION: Here, we present a case of a boy with persistent dysphagia who had a thorough diagnostic workup and was eventually diagnosed with EIPD.
Asunto(s)
Trastornos de Deglución/etiología , Diverticulosis Esofágica/complicaciones , Esófago/patología , Reflujo Gastroesofágico/diagnóstico , Niño , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico , Humanos , Masculino , Manometría/métodosAsunto(s)
Diverticulosis Esofágica/diagnóstico , Diverticulosis Esofágica/cirugía , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/cirugía , Adulto , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Diverticulosis Esofágica/complicaciones , Estenosis Esofágica/etiología , Esofagoscopía/métodos , Estudios de Seguimiento , Gastroscopía/métodos , Humanos , Masculino , Neumonía por Aspiración/diagnóstico , Neumonía por Aspiración/etiología , Recuperación de la Función , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Intramural pseudodiverticulosis of the esophagus is a rare benign disease of the eosphageal wall, with dilation of the submucosal glands, and the predominant symptom is dysphagia. This disorder may be associated with gastroesophageal reflux, motility disorders, candidiasis and alcoholism. Inflammation, resulting in periductal fibrosis and compression of the duct orifices, may be a causative factor. Good and long-lasting therapeutic success can be achieved by bouginage of the stenosis with concomitant treatment of the associated esophageal diseases. Esophageal intramural pseudodiverticulosis is a differential diagnosis in cases of dyspagia and/or esophageal strictures if no other causes are found.
Asunto(s)
Trastornos de Deglución/etiología , Diverticulosis Esofágica/diagnóstico , Estenosis Esofágica/etiología , Anciano , Humanos , Masculino , RecurrenciaAsunto(s)
Diverticulosis Esofágica/complicaciones , Esofagitis/complicaciones , Hernia Diafragmática/complicaciones , Síndrome de Mallory-Weiss/etiología , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico , Endoscopía Gastrointestinal/métodos , Esofagitis/diagnóstico , Hernia Diafragmática/diagnóstico , Humanos , Síndrome de Mallory-Weiss/diagnósticoAsunto(s)
Trastornos de Deglución/etiología , Diverticulosis Esofágica/complicaciones , Estenosis Esofágica/etiología , Candidiasis/complicaciones , Candidiasis/diagnóstico , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico , Neoplasias Esofágicas/diagnóstico , Esofagitis/complicaciones , Esofagitis/diagnóstico , Esofagoscopía , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Diverticulosis Esofágica/diagnóstico , Endoscopía Gastrointestinal/métodos , Radiografía Torácica/métodos , Administración Oral , Sulfato de Bario/administración & dosificación , Biopsia , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Dilatación/métodos , Diverticulosis Esofágica/terapia , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Diverticulosis Esofágica/diagnóstico , Endoscopía del Sistema Digestivo , Esofagitis/patología , Esófago/patología , Dolor Abdominal , Adulto , Diagnóstico Diferencial , Diverticulosis Esofágica/diagnóstico por imagen , Diverticulosis Esofágica/patología , Femenino , Humanos , Cirrosis Hepática Alcohólica/complicaciones , RadiografíaRESUMEN
We report two cases of esophageal intramural pseudodiverticulosis (EIPD). EIPD is a rare condition characterized by multiple flask-shaped outpouchings in the esophageal wall representing dilated excretory ducts of submucosal glands. Dysphagia is the leading symptom. On endoscopy, minute openings in the esophageal wall, and sometimes a segmental candida esophagitis or a benign stenosis not originating from an erosive reflux esophagitis are found.
Asunto(s)
Trastornos de Deglución/etiología , Diverticulosis Esofágica/diagnóstico , Estenosis Esofágica/diagnóstico , Anciano , Candidiasis/complicaciones , Candidiasis/diagnóstico , Diagnóstico Diferencial , Dilatación , Diverticulosis Esofágica/complicaciones , Estenosis Esofágica/complicaciones , Estenosis Esofágica/terapia , Esofagitis/complicaciones , Esofagitis/diagnóstico , Esofagoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
This report describes the clinical course of a patient with complications of esophageal intramural pseudodiverticulosis. The condition led to fistulization and abscess formation in the mediastinum. The initial presentation was for the septic process and appropriate antibiotic therapy led to infection control while the abscess drained spontaneously back into the esophageal lumen. A long stricture affecting the distal half of the esophagus became evident after a few months and could not be managed by repeat dilatations. After appropriate preparation, subtotal esophagectomy was offered to the patient with an initial right thoracic approach followed by laparotomy and left cervical reconstruction. A total gastric tube was used for reconstruction and placed in a substernal position. An uneventful postoperative evolution led to normal swallowing comfort.