(See also Overview of Esophageal and Swallowing Disorders Overview of Esophageal and Swallowing Disorders The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). The upper third of the esophagus... read more .)
Small diverticula in the upper esophagus were noted incidentally in this patient during an evaluation for nausea and vomiting.
Image provided by David M. Martin, MD.
Zenker diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle. In this image, the diverticulum is on the left, next to the triangular opening of the trachea formed by the vocal cords.
Image provided by David M. Martin, MD.
Traction diverticula are midesophageal outpouchings of mucosa and submucosa caused by motility disorders or by traction resulting from mediastinal processes. In this image, the diverticulum is to the right of the esophagus and gives the appearance of a double lumen.
Image provided by David M. Martin, MD.
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 resulting from mediastinal inflammatory lesions or, secondarily, by esophageal motility disorders Esophageal Motility Disorders Esophageal motility disorders involve dysfunction of the esophagus that causes symptoms such as dysphagia, heartburn, and chest pain. (See also Overview of Esophageal and Swallowing Disorders... read more .
Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder (eg, achalasia Achalasia Achalasia is a neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and a lack of lower esophageal sphincter relaxation during swallowing. Symptoms are slowly... read more , diffuse esophageal spasm Diffuse Esophageal Spasm Symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders characterized variously by nonpropulsive contractions and hyperdynamic contractions, sometimes in conjunction... read more ).
Symptoms and Signs of Esophageal Diverticula
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 of Esophageal Diverticula
Barium swallow
All diverticula are diagnosed by videotaped barium swallow and often confirmed on upper endoscopy.
Treatment of Esophageal Diverticula
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. There are also emerging endoscopic treatment options for diverticulectomy.
