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Esophageal Pouches (Diverticula)

(Esophageal Diverticula)


Kristle Lee Lynch

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

Last full review/revision Oct 2020| Content last modified Oct 2020
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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 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.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus.)

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.

Zenker diverticula (pharyngeal diverticula)

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.

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 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 or corrected endoscopically.

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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