Esophageal pseudodiverticulosis

Last revised by Abenezer Zinaye on 3 Dec 2022

Esophageal intramural pseudodiverticulosis is an uncommon condition in which there are numerous small outpouchings within the esophageal wall.

It is a rare condition, found in <1% of esophagograms. It may occur at any age, but is more common between 50 and 70 years. There is a slight male predominance 2.

Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal mucosal glands 1.

Barium swallow examination is the study of choice, as the ductal orifices may be too small to be seen on endoscopy. Pseudodiverticula are better seen with a single contrast examination than with a double contrast, thin barium examination 1,2

  • numerous, tiny (1-4 mm), flask-shaped outpouchings

  • may be diffusely distributed or clustered

  • clustering may occur next to peptic strictures

  • viewed in profile, often appear “floating” next to the esophageal wall, as the channel to the lumen is imperceptible

  • viewed en face, may appear as ulcers 3

  • intramural tracking may sometimes be seen bridging two or more pseudodiverticula 2 

The treatment of esophageal pseudodiverticulosis is dependent on symptoms displayed and accompanying conditions 5. Around 10% of patients do no require treatment 6. The use of proton pump inhibitors can help relieve symptoms of esophagitis. If esophageal strictures are present, the use of endoscopic dilatation helps improve treatment response 5.

Pseudodiverticular rupture with resultant mediastinitis has been reported but is very rare 4.

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