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Esophageal Pouches (Diverticula)

(Esophageal Diverticula)

By Michael C. DiMarino, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University

Esophageal pouches (diverticula) are abnormal protrusions from the esophagus that in rare cases cause swallowing difficulties and regurgitation (the spitting up of food from the esophagus or stomach without nausea or forceful contractions of abdominal muscles).

There are several types of esophageal diverticula. Each has a different cause, but probably all are related to uncoordinated swallowing and muscle relaxation. Most of these diverticula are associated with motility disorders of the esophagus, such as esophageal spasm and achalasia (see Abnormal Propulsion of Food).

Zenker diverticula

A pharyngeal pouch or Zenker diverticulum is probably caused by an incoordination between movement of food out of the mouth and relaxation of the cricopharyngeal muscle. This diverticulum can fill with food, which may be regurgitated when the person bends over or lies down. This regurgitation may also cause food to be inhaled into the lungs during sleep, resulting in aspiration pneumonia. Rarely, the pouch enlarges and causes difficulty swallowing (dysphagia—see Difficulty Swallowing) and sometimes a swelling in the neck.

Midesophageal diverticula

A midesophageal pouch or traction diverticulum is caused by traction resulting from inflamed lesions located in the chest outside the esophagus (mediastinum) or by esophageal movement (motility) disorders. A traction diverticulum rarely causes symptoms, but the underlying disorder may.

Epiphrenic diverticula

An epiphrenic pouch or diverticulum occurs just above the diaphragm and usually accompanies a motility disorder (such as achalasia or esophageal spasm). An epiphrenic diverticulum rarely causes symptoms, but the underlying disorder may.

Diagnosis and Treatment

All diverticula are diagnosed with a videotaped barium swallow.

Treatment is not usually needed. If symptoms are severe or the pouch is large, however, the pouch can be removed surgically. Diverticula associated with motility disorders require treatment of the underlying disorder. For example, if a Zenker diverticulum is caused by an abnormally functioning cricopharyngeal muscle, a doctor can cut the muscle (myotomy) when removing the Zenker diverticulum. When esophageal spasm or achalasia is present, treatment of sphincter tightness may be needed.

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