Esophageal Diverticulum: Symptoms, Causes, Treatment

What are the symptoms of esophageal diverticulum?

Esophageal diverticulum is a condition where a pouch or sac develops in the esophagus. The symptoms can vary depending on the type of diverticulum (true or false) and its size. Common symptoms may include:

1. Difficulty swallowing (dysphagia)
2. Regurgitation of food or liquids
3. Feeling of a lump in the throat
4. Coughing or choking, especially when eating
5. Bad breath (halitosis)
6. Heartburn or acid reflux
7. Chest pain or discomfort
8. Unintended weight loss (in severe cases)

It’s important to note that esophageal diverticula are relatively rare and often asymptomatic. If you experience any persistent or severe symptoms, it’s advisable to consult with a healthcare professional for an accurate diagnosis and appropriate management.

What are the causes of esophageal diverticulum?

Esophageal diverticula can be classified into two main types based on their causes:

1. Zenker’s diverticulum: This type occurs in the upper esophagus, typically above the cricopharyngeal muscle. It is often caused by a dysfunction or spasm of this muscle, which normally helps to open and close the upper esophageal sphincter during swallowing. This dysfunction can lead to increased pressure in the area, causing a pouch to form.
2. Epiphrenic diverticulum: This type occurs in the lower part of the esophagus, usually near the lower esophageal sphincter. It is often associated with conditions that cause increased pressure in the esophagus, such as achalasia (a condition where the lower esophageal sphincter fails to relax properly) or esophageal motility disorders.

Other factors that may contribute to the development of esophageal diverticula include:

• Chronic, forceful coughing
• Chronic, heavy lifting
• Structural abnormalities of the esophagus
• History of radiation therapy to the chest
• Inflammatory conditions of the esophagus

The exact cause of esophageal diverticula may vary depending on the individual and the specific type of diverticulum.

How is the diagnosis of esophageal diverticulum made?

The diagnosis of esophageal diverticulum typically involves a combination of medical history review, physical examination, and various diagnostic tests. These may include:

1. Barium swallow: This is a special X-ray procedure where you drink a liquid containing barium, which coats the inside of the esophagus and stomach. X-ray images are then taken to detect any abnormalities, such as a diverticulum.
2. Esophagoscopy: A thin, flexible tube with a camera on the end (endoscope) is passed through the mouth and into the esophagus to visually inspect the lining of the esophagus. This can help identify the presence of a diverticulum and evaluate its size and location.
3. Esophageal manometry: This test measures the pressure and movement of the esophagus as you swallow. It can help diagnose conditions like achalasia, which may be associated with esophageal diverticula.
4. CT scan or MRI: These imaging tests may be used to get more detailed images of the esophagus and surrounding structures, which can help in the diagnosis and evaluation of the diverticulum.
5. Upper endoscopy (esophagogastroduodenoscopy, or EGD): In this procedure, a thin, flexible tube with a camera is passed through the mouth and into the esophagus, stomach, and duodenum. It allows for direct visualization of the esophageal lining and can help identify a diverticulum.

The specific tests ordered may vary depending on the suspected type and location of the diverticulum, as well as the individual’s symptoms and medical history.

What is the treatment for esophageal diverticulum?

The treatment for esophageal diverticulum depends on the type and size of the diverticulum, as well as the presence of symptoms. In many cases, small diverticula that are not causing symptoms may not require treatment. However, larger or symptomatic diverticula may require intervention. Treatment options may include:

1. Dietary and lifestyle changes: Avoiding foods that can exacerbate symptoms, such as spicy or acidic foods, and eating smaller, more frequent meals can help reduce symptoms associated with esophageal diverticula.
2. Medications: Proton pump inhibitors (PPIs) or H2 blockers may be prescribed to reduce acid production and alleviate symptoms of acid reflux, which can worsen symptoms of esophageal diverticula.
3. Endoscopic therapy: For Zenker’s diverticulum, endoscopic techniques such as diverticulotomy or diverticuloplasty may be used to surgically treat the diverticulum. These procedures involve making a small incision in the diverticulum to improve food passage and reduce symptoms.
4. Surgery: In some cases, surgical removal of the diverticulum may be necessary, especially for large diverticula or those that are causing severe symptoms. This is typically done using minimally invasive techniques such as laparoscopy.
5. Botulinum toxin injection: In cases of Zenker’s diverticulum, injecting botulinum toxin into the cricopharyngeal muscle can help relax the muscle and reduce pressure in the area, which may alleviate symptoms.

The choice of treatment depends on various factors, including the size and location of the diverticulum, the severity of symptoms, and the individual’s overall health. It’s important to consult with a healthcare provider to determine the most appropriate treatment approach for esophageal diverticulum.