Weill Cornell Medicine New York, NY, United States
Fatima Morales Delgado, BA1, Emily S. Smith, MD1, David Wan, MD2, Alyson Kaplan, MD3 1Weill Cornell Medicine, New York, NY; 2New York Presbyterian Weill Cornell Medicine, New York, NY; 3New York Presbyterian - Weill Cornell Medicine, New York, NY
Introduction: Esophageal Intramural Pseudodiverticulosis (EIP) is a rare, benign disease which causes dysphagia and odynophagia. It’s associated with frequent tobacco and alcohol use, recurrent esophagitis due to infection or uncontrolled gastroesophageal reflux disease. Despite the prevalence of risk factors for EIP, the understanding of the disease still remains limited.
Case Description/Methods: A 53-year-old man with HIV, hypertension, uncontrolled diabetes mellitus, polysubstance use disorder, recurrent esophageal candidiasis and a benign, chronic esophageal stricture status post stenting 5 years prior presented to the hospital with dysphagia and odynophagia for 2 weeks. He reported tactile fevers, dysphagia with both solids and liquids, and a 2kg weight loss. Labs were notable for HIV viral load 4.67 Log Copies/mL, T-Helper absolute count 169. Esophagogastroduodenoscopy revealed a benign, chronic upper esophageal stenosis and innumerable diverticula in the mid-distal esophagus with concomitant scattered white plaques (Figure 1). Esophageal fluoroscopy redemonstrated innumerable pseudodiverticula with no evidence of a leak or fistula. The patient was empirically started on fluconazole 400mg by mouth daily for 21 days and a proton pump inhibitor (PPI). Pathology revealed active esophagitis with negative stains for HSV, CMV, and fungal organisms. Odynophagia and dysphagia resolved on 90 day follow up. However, on barium esophagram there was an irregular contour and reticulation consistent with persistent esophagitis versus pseudodiverticulosis.
Discussion: EIP is a chronic inflammatory disease with uncertain pathophysiology. Histology reveals the pseudodiverticula are dilated submucosal glands with surrounding inflammatory cells. Most often it presents asymptomatic or with dysphagia, odynophagia, and less commonly, food impaction. There is no reported association between HIV and EIP. The immunocompromised state and large pill burden in this population, associated with increased risk of infectious and pill esophagitis, likely leaves a large cohort of underreported EIP. The treatment goal is to temporize symptoms. Removing the stimulus for the inflammation is essential. PPIs, antimicrobials, and stricture dilatation are effective treatments. In this patient with HIV, management of EIP is important to ensure medical compliance of antiretroviral therapy to prevent further morbidity.
Figure: Figure 1: A. Middle third of the esophagus; B. lower third of the esophagus; C. Esophageal Fluoroscopic Imaging During Esophagogastroduodenoscopy; D Barium Esophagram on 90 day Follow up
Disclosures: Fatima Morales Delgado indicated no relevant financial relationships. Emily Smith indicated no relevant financial relationships. David Wan indicated no relevant financial relationships. Alyson Kaplan indicated no relevant financial relationships.
Fatima Morales Delgado, BA1, Emily S. Smith, MD1, David Wan, MD2, Alyson Kaplan, MD3. P1387 - A Case of Esophageal Intramural Pseudodiverticulosis in Patient With Uncontrolled HIV, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
