An esophageal diverticulum is a protruding pouch in the lining of the esophagus. It forms in a weak area of the esophagus. The pouch can be anywhere from 1 to 4 inches in length.
There are three types of esophageal diverticula (plural of diverticulum), based on where they’re located:
- Zenker’s diverticulum. This type develops near the top of the esophagus.
- Midthoracic diverticulum. This type occurs in the middle part of the esophagus.
- Epiphrenic diverticulum. This type is located in the lower part of the esophagus.
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Esophageal diverticula don’t always cause problems. When they do, the symptoms tend to come on slowly as the pouch grows.
Common symptoms of an esophageal diverticulum include:
- difficulty swallowing
- feeling like food is caught in the throat
- regurgitating food when bending over, lying down, or standing up
- pain when swallowing
- chronic cough
- bad breath
- chest pain
- neck pain
- weight loss
- vocal changes
- Boyce’s sign, which is a gurgling sound when air passes through the diverticulum
Experts aren’t sure about the exact causes of esophageal diverticula. Some people are born with it, while other develop it later in life.
In adults, it’s often associated with increased pressure within the esophagus. This pressure causes the lining to protrude in a weakened area. Potential causes of this increased pressure include:
- malfunction of the sphincters on either end of the esophagus
- inflammation from outside the esophagus
- food not moving properly through the esophagus
- malfunctioning of the swallowing mechanism
It can also be a complication of a surgical procedure near the neck, or conditions that affect collagen, such as Ehler-Danlos syndrome.
While an esophageal diverticulum can occur at any age, it’s most common in people in their 70s and 80s. In addition, people with swallowing disorders are more likely to develop it.
There are several methods your doctor can use to diagnose an esophageal diverticulum, including:
- Barium swallow. You’ll be asked to swallow a solution containing barium, which shows up on an X-ray or CT scan. This allows your doctor to track the movement of fluid through your esophagus.
- Gastrointestinal endoscopy. For this procedure, your doctor inserts a thin, flexible tube with a camera at the end through your mouth and down your throat in order to view your esophagus.
- Esophageal manometry. This technique measures the timing and strength of the contractions of your esophagus.
- 24-hour pH test. This test measures the pH in your esophagus over a 24-hour period to check for signs of stomach acid or bile in your esophagus.
There are several treatment options for an esophageal diverticulum, depending on its size and severity.
Mild esophageal diverticula can usually be managed through lifestyle changes, such as:
- thoroughly chewing your food
- eating a bland diet
- drinking lots of water after you eat to help with digestion.
Over-the-counter antacids can also help with mild symptoms.
More severe cases may require surgery to remove the pouch and repair weakened tissue in the esophagus.
Surgical procedures to do this include:
- Cricopharyngeal myotomy. This involves making small cuts in the upper sphincter of the esophagus to widen it, so food can pass more easily through your esophagus.
- Diverticulopexy with cricopharyngeal myotomy. This involves removing a larger diverticulum by turning it upside down and attaching it to the wall of the esophagus.
- Diverticulectomy and cricopharyngeal myotomy. This involves removing the diverticulum while performing a cricopharyngeal myotomy. It’s a combination that’s often used to treat Zenker’s diverticula.
- Endoscopic diverticulotomy. This is a minimally invasive procedure that divides the tissue between the diverticulum and esophagus, allowing food to drain from the diverticulum.
Over time, an esophageal diverticulum can lead to some health complications.
- Aspiration pneumonia. If an esophageal diverticulum causes regurgitation, it can lead to aspiration pneumonia. This is a lung infection caused by inhaling things, such as food and saliva, that usually travel down your esophagus.
- Obstruction. An obstruction near the diverticulum can make it hard, if not impossible, to swallow. This can also cause the pouch to rupture and bleed.
- Squamous cell carcinoma. In very rare cases, ongoing irritation of the pouch can lead to squamous cell carcinoma.
An esophageal diverticulum is a fairly rare condition that tends to affect older adults. While some people never have any symptoms, others experience a range of issues, including difficulty swallowing and regurgitation. Most cases respond well to lifestyle changes, surgery, or a combination of both.