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 Throat and Esophagus The throat (pharynx) lies behind and below the mouth. When food and fluids leave the mouth, they pass through the throat. Swallowing of food and fluids begins voluntarily and continues automatically... read more is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus Overview of the Esophagus The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. Food does not just fall through the esophagus into the stomach. The walls of the esophagus propel food to... read more .)
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 Abnormal Propulsion of Food The movement of food from mouth to stomach requires normal and coordinated action of the mouth and throat, propulsive waves of muscular contractions of the esophagus (called peristalsis), and... read more , such as esophageal spasm Esophageal Spasm Esophageal spasm is a disorder of the rhythmic waves of muscular contractions (peristalsis) of the esophagus. The cause of this disorder is not known. Symptoms include chest pain and difficulty... read more and achalasia Achalasia Achalasia is a disorder in which the rhythmic contractions of the esophagus (called peristalsis) are missing or impaired, the lower esophageal sphincter does not relax normally, and the resting... read more .
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 Propulsion Disorders of the Throat Propulsion disorders of the throat can cause trouble moving food from the upper part of the throat into the esophagus (the hollow tube that leads from the throat [pharynx] to the stomach). People... read more ). 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 Aspiration Pneumonia and Chemical Pneumonitis Aspiration pneumonia is lung infection caused by inhaling mouth secretions, stomach contents, or both. Chemical pneumonitis is lung irritation caused by inhalation of substances irritating or... read more . Rarely, the pouch becomes larger and causes difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more (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 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 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.
