Esophageal Pouches (Diverticula)
(See also Overview of the Esophagus.)
Esophageal diverticula are abnormal pouches or pockets in the esophagus. Rarely, they cause swallowing difficulties and regurgitation (the spitting up of food without nausea or forceful contractions of abdominal muscles).
The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.
There are several types of esophageal diverticula. Each has a different cause, but probably all are related to uncoordinated swallowing and muscle relaxation. Many of these diverticula are associated with motility disorders of the esophagus, such as esophageal spasm and achalasia.
A Zenker diverticulum is probably caused by an incoordination between movement of food out of the mouth and relaxation of the cricopharyngeal muscle (cricopharyngeal incoordination). This diverticulum can fill with food, which may be spit up (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 becomes larger and causes difficulty swallowing (dysphagia) and sometimes a swelling in the neck.
Doctors diagnose all types of esophageal diverticula by doing a barium swallow (esophogram). In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see. Sometimes the barium swallow is videotaped so doctors can record it.
Treatment of diverticula 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 (a procedure called myotomy) when removing the Zenker diverticulum. When esophageal spasm or achalasia is present may be needed.