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Esophageal Pouches (Diverticula)

(Esophageal Diverticula)

By

Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Feb 2024
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Esophageal diverticula are abnormal pouches or pockets in the esophagus. Rarely, they cause swallowing difficulties and regurgitation Regurgitation and Rumination Regurgitation is the spitting up of food from the esophagus or stomach without nausea or forceful contractions of the abdominal muscles. Rumination is regurgitation with no apparent physical... read more (the spitting up of food without nausea or forceful contractions of abdominal muscles).

  • The cause depends on the type of diverticula.

  • Symptoms include spitting up of food and difficulty swallowing.

  • The diagnosis is based on the results of barium swallow x-rays and often upper endoscopy.

  • When needed, treatment includes surgery.

Zenker diverticula (pharyngeal diverticula)

Midesophageal diverticula (traction diverticula)

A midesophageal diverticulum is caused by inflammation located in the chest cavity outside the esophagus that pulls on the esophagus or is caused by esophageal motility disorders.

A midesophageal diverticulum rarely causes symptoms, but the underlying motility disorder may.

Epiphrenic diverticula

An epiphrenic diverticulum occurs just above the diaphragm (the muscle that separates the chest from the abdomen) and usually occurs along with a motility disorder (such as achalasia or esophageal spasm).

An epiphrenic diverticulum rarely causes symptoms, but the underlying motility disorder may.

Diagnosis of Esophageal Pouches

  • Barium swallow x-rays

  • Often upper endoscopy

Doctors diagnose all types of esophageal diverticula by doing a barium swallow (esophagram). 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 have a recording of it.

Doctors often do an upper endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more to confirm the diagnosis. During upper endoscopy, doctors examine the esophagus by using a flexible tube called an endoscope.

Treatment of Esophageal Pouches

  • Usually no treatment

  • Sometimes surgery

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.

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