Esophageal diverticulum: anatomy, causes, meaning

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An esophageal diverticulum is a pouch or sac that protrudes from the wall of the esophagus, the tube through which food passes from the mouth to the stomach. “Esophageal diverticula” refers to a single pocket, and “esophageal diverticula” refers to multiple pockets. It is a rare disease that affects less than 1% of the population.

Esophageal diverticula can be present from birth, but they can also develop later in a person’s life.

This article will discuss the anatomy of esophageal diverticula, symptoms, and treatment options.

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Anatomy

Arenas of esophageal diverticula protruding from the wall of the esophagus. The esophagus is the tube that connects the mouth to the stomach. Esophageal diverticula protrude into the weak parts of the esophageal lining. It can happen anywhere along the esophagus.

The pouches found in esophageal diverticula can be up to 4 inches in diameter. In some people, there are a number of smaller diverticula throughout the esophagus.

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The sacs found in the esophageal diverticula can appear anywhere on the esophagus. Esophageal diverticula are classified differently based on their location along the esophagus and include:

  • Zenker’s diverticula: These are esophageal diverticula found in the upper part of the esophagus.
  • Middle Esophageal Diverticula: The pouches are located in the middle of the esophagus.
  • Epphiphrenic diverticula: Pockets are found at the base of the esophagus.

Most often, puffiness is found in middle-aged or older people.

Anatomical variations

Esophageal diverticula can form in a number of ways.

Traction diverticula

An esophageal diverticulum known as a traction diverticulum occurs when there is an external force on the wall of the esophagus that creates the pocket. This most often occurs in the middle area of ​​the esophagus.

Pulsating diverticula

Also called epiphanic diverticula, these pockets are found in the lower part of the esophagus. It happens when the esophagus is pushed out due to an incoordination of the sphincter muscle in the lower part of the esophagus. The sphincter is a ring made of muscle that connects the esophagus to the stomach.

Zenker’s diverticulum

Occurring in the upper part of the esophagus, a Zenker’s diverticulum is caused by an abnormal tightening of the upper esophageal sphincter between the lower pharynx (throat) and the upper esophagus. This causes a bulge to form, and over time the pressure will cause a diverticulum to develop. It is the most common type of esophageal diverticulum.

Causes

Esophageal diverticula can be congenital (present at the time of birth) but can also form later in life.

Usually, esophageal diverticula form either due to pressure from outside the esophagus, infection or inflammation of the chest, or when there is pressure inside the esophagus. the esophagus when you eat.

The most common cause of esophageal diverticula is a motility disorder, when the muscles involved in digestion stop working properly.

Motility disorders can prevent the muscles in the esophagus from working properly and moving food from the mouth to the stomach efficiently. These include:

  • Esophageal scleroderma (hardening or tightening of the esophagus)
  • Achalasia (a condition in which the nerves in the esophagus are damaged)

These disorders can also cause esophageal diverticula:

  • Esophagitis, an inflammation of the lining of the esophagus
  • Sphincter disorders in the upper or lower parts of the esophagus
  • Weakness of the walls of the esophagus

Clinical significance

Most people with esophageal diverticula are asymptomatic and may never be diagnosed with the disease until symptoms appear or the sacs are detected during imaging tests for another disease.

People with esophageal diverticula often do not receive treatment unless their symptoms are severe. In this case, surgery may be performed to remove the bags.

Diagnostic

Many people with esophageal diverticula will never be diagnosed because they are asymptomatic.

If a person has symptoms, a doctor will take their medical history, do a physical exam, and may perform tests to make a diagnosis.

Possible tests for esophageal diverticula include:

  • Barium swallow / esophagus: With this test, you will be asked to drink a chalky liquid containing barium before an x-ray. Barium covers the wall of the esophagus and provides contrast so that the esophagus and any growths are easily visible on an x-ray.
  • Endoscopic endoscopic evaluation of swallowing (FEES): In this test, a long tube with a light and a camera, called an endoscope, is inserted into the esophagus through the mouth. The doctor may use the endoscope to examine the esophagus and take tissue samples.

Symptoms

Symptoms are often present when an esophageal diverticulum is more than 2 inches in width.

Esophageal diverticula can cause symptoms ranging from mild to severe. These include:

  • Pain on swallowing (odynophagia)
  • Difficulty swallowing (dysphagia)
  • Stomach pains
  • Sensation of food stuck in the throat
  • A chronic cough
  • Chest pain
  • Bad breath
  • Aspiration pneumonia
  • Regurgitation (partially digested food moving up the throat from the stomach)

As the bags associated with the esophageal diverticulum stretch over time, symptoms may worsen.

Complications

In some people, irritation of the esophagus can increase the risk of esophageal cancer.

In rare cases, an esophageal diverticulum can cause an abnormal connection between the esophagus and the airways (an abnormality called bronchoesophageal fistula) to form. A 2017 study reported that there were less than 50 known cases of this phenomenon.

Other possible complications of esophageal diverticula include:

  • Perforation of the esophagus
  • Obstruction of the esophagus
  • Squamous cell carcinoma (cancer of the cells that line the surface of the esophagus)

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If a person has esophageal diverticula but no symptoms, the bags are left alone. Your healthcare professional will carefully monitor their growth and check for your symptoms.

But for those with symptoms, surgical and treatment options are available. Surgical options include:

  • Surgery to remove diverticula, either laparoscopically or by open surgery
  • Myotomy surgery, in which the muscle of the esophageal sphincter is cut laparoscopically to open the sphincter.

Non-surgical options include:

  • Eat bland foods
  • Chew carefully
  • Take small bites
  • Drink water during and after meals
  • Sitting totally upright while eating


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