Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2024; 30(2): 137-145
Published online Jan 14, 2024. doi: 10.3748/wjg.v30.i2.137
Esophageal intramural pseudodiverticulosis
Masako Shintaku
Masako Shintaku, Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata 573-8511, Osaka, Japan
Author contributions: Shintaku M wrote the manuscript.
Conflict-of-interest statement: The author declares no conflict of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Masako Shintaku, MD, Doctor, Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata 573-8511, Osaka, Japan.
Received: November 19, 2023
Peer-review started: November 19, 2023
First decision: December 15, 2023
Revised: December 21, 2023
Accepted: December 28, 2023
Article in press: December 28, 2023
Published online: January 14, 2024

Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the “pseudodiverticula” periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.

Keywords: Esophageal endoscopy, Esophageal intramural pseudodiverticulosis, Esophagography, Dysphagia

Core Tip: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease in which the ducts of the esophageal glands become cystically dilated. Prolonged chronic inflammation can lead to esophageal stenosis, perforation, mediastinitis, and lung abscess. EIPD needs to be diagnosed at an early stage, and patients should be carefully observed and treated appropriately.