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Esophageal Diverticula

by Michael C. DiMarino, MD

An esophageal diverticulum is an outpouching of mucosa through the muscular layer of the esophagus. It can be asymptomatic or cause dysphagia and regurgitation. Diagnosis is made by barium swallow; surgical repair is rarely required.

There are several types of esophageal diverticula, each of different origin.

  • Zenker (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation.

  • Midesophageal (traction) diverticula are caused by traction from mediastinal inflammatory lesions or, secondarily, by motility disorders.

  • Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder (achalasia, diffuse esophageal spasm).

Symptoms and Signs

A Zenker diverticulum fills with food that might be regurgitated when the patient bends or lies down. Aspiration pneumonitis may result if regurgitation is nocturnal. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass.

Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be.

Diagnosis

All diverticula are diagnosed by videotaped barium swallow.

Treatment

  • Usually none

  • Sometimes surgical resection

Specific treatment is usually not required, although resection is occasionally necessary for large or symptomatic diverticula. Diverticula associated with motility disorders require treatment of the primary disorder. For example, case reports suggest doing a cricopharyngeal myotomy when resecting a Zenker diverticulum.

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