What is Esophageal Diverticula?
An esophageal diverticulum is a rare condition where a part of the esophagus, the tube that connects your throat to your stomach, bulges outwards. This usually doesn’t cause any problems, but people may experience regurgitation or difficulty swallowing if they have this issue.
There are several ways to categorize esophageal diverticulum. One way is to divide them into true and false diverticula. True diverticula involve the entire thickness of the esophageal wall bulging out, whereas false diverticula only include the inner lining or just beneath.
Another way to categorize esophageal diverticulum is by how they form: through pulsion or traction. Pulsion diverticula are formed when there’s increased pressure inside the esophagus pushing onto a weak spot in the wall, usually due to issues in the esophagus’s movement. Traction diverticula happen when an external force, such as inflammation outside the esophagus, pulls and sticks onto the esophageal wall, resulting in a bulge.
Esophageal diverticula can also be classified by their location. They can occur near the throat (pharyngeal or Zenker diverticula), in the middle of the esophagus (mid-esophageal diverticula), or near the bottom part of the esophagus (epiphrenic diverticula). Pharyngeal diverticula are usually false diverticula that commonly occur in a weak area near the throat known as Killian’s triangle. Mid-esophageal diverticula are typically true diverticula and often result from inflammation outside the esophagus. Epiphrenic diverticula, like pharyngeal diverticula, are usually false diverticula, and they often occur due to issues with the esophagus’s movement, resulting in increased pressure at the bottom of the esophagus.
Esophageal diverticula can happen to anyone, regardless of their age, but they usually affect adults. Zenker’s diverticulum, in particular, is most common in older people.
What Causes Esophageal Diverticula?
The cause of esophageal diverticula, which are small pouches that can form in the lining of your esophagus, isn’t completely understood. However, some believe these pouches are created when there’s an increase in the pressure inside the esophagus. This pressure pushes outward at weak spots in the esophagus lining, creating a small, pouch-like bulge.
Esophageal diverticula can also happen as a result of an esophageal motility disorder – a condition that affects the muscle movements in your esophagus. Achalasia is an example of such a disorder.
Risk Factors and Frequency for Esophageal Diverticula
Esophageal diverticula, a condition affecting the esophagus, is not common and affects less than 1% of people. However, among those who report difficulty swallowing, approximately 1% to 3% are diagnosed with this condition. While it can occur at any age, it is typically diagnosed in older people. Also, men are usually affected more than women.
Signs and Symptoms of Esophageal Diverticula
People with symptoms of a diverticulum, a pouch that can form in the digestive system, often complain about difficulty swallowing, a condition medically known as dysphagia. Other common complaints could include having food come back up, catching pneumonia from inhaled food or fluids, unexplained weight loss, bad breath, and coughing due to food getting stuck in the pouch. Rarely, some might feel a lump in their neck. However, it’s important to note that many people don’t have any noticeable symptoms and may not even know they have a diverticulum until they start experiencing symptoms.
Other symptoms that can occur include producing excess saliva, coughing, feeling as if food is lodged at the back of the throat, and regurgitating food soon after eating it.
Testing for Esophageal Diverticula
Most patients with certain types of throat and stomach disorders are typically diagnosed using a test called a barium esophagogram. This involves swallowing a type of contrast material called barium, which helps doctors to see the esophagus and stomach area more clearly in X-ray images. This procedure helps to provide information about the location and size of any potential issues.
Another test that could be carried out to confirm the diagnosis is an esophagogastroduodenoscopy. This procedure involves using a thin tube with a camera on the end to see the inside of the esophagus, stomach, and the first part of the small intestine. This test can sometimes be the initial diagnostic test. Sometimes, issues can also unexpectedly turn up on video swallow studies, which involve watching a video of a person swallowing to identify any potential problems.
However, it’s important to note that endoscopy procedures can be risky, as there is a real risk of tearing the esophagus, a condition known as esophageal perforation.
Additionally, to eliminate the possibility of certain disorders involving the muscles used for swallowing, a test called manometry might be done. Manometry measures the rhythm and force of muscle contractions in the esophagus when you swallow.
Treatment Options for Esophageal Diverticula
When patients have diverticula (small pouches that bulge out from the digestive tract) but don’t experience any symptoms, doctors usually avoid doing anything that might disrupt them. This is a common approach for diverticula that are located in the middle of the esophagus or in the region just above the diaphragm.
If patients do experience symptoms, however, there are a number of ways they can be treated. This is more common for diverticula located in the throat area. The treatment options range from surgical procedures that either remove, fix, or invert the diverticulum, sometimes combined with a procedure called a myotomy (a surgical cutting of a muscle). The operations can be performed via traditional open surgery or a laparoscopic approach, which involves small keyhole incisions. Most often though, patients undergo a less invasive procedure that involves using a flexible or rigid tube with a light and camera (known as an endoscope) to perform myotomy and remove the pouch.
If patients aren’t candidates for surgery, their condition can be managed with dietary changes. Bland foods and drinking water after every bite to help flush any food out of the diverticulum is often recommended.
For a specific type of diverticulum known as a Zenker diverticulum, located in the throat, surgery involves removing the diverticulum and performing a small myotomy to reduce pressure in the lower throat.
Nowadays, endoscopic treatments are becoming a more popular choice over surgery. Such procedures involve using a rigid endoscope to cut the link between the esophagus and the diverticulum and performing a small myotomy.
What else can Esophageal Diverticula be?
When looking at what might be causing esophageal issues, doctors may consider several possibilities. These can include:
- Achalasia (a rare disorder that makes it hard for food and liquid to pass into your stomach)
- Esophageal cancer (cancer of the tube that runs from your throat to your stomach)
- Esophageal stricture (a narrowing or tightening of the tube that brings food from your mouth to your stomach)
- Gastroesophageal reflux (a digestive disease in which stomach acid irritates the lining of the food pipe)
- Presbyesophagus (a condition that impacts the strength and coordination of muscular contractions in the esophagus)
A thorough understanding of the patient’s history is key for the doctor to correctly identify which of these might be causing the problem.
What to expect with Esophageal Diverticula
The outlook for patients with this condition depends on their age and other existing health problems, as these factors will guide whether they can safely undergo surgery. The decision to proceed to surgery needs to be carefully analysed by weighing the benefits against the risks. Most patients respond well to surgery, with an immediate decrease in their symptoms and varied chances of the problem returning. However, it’s worth mentioning that surgery does carry the risk of severe complications. These risks need to be taken into account when deciding whether to opt for surgical treatment and the specific type of surgical approach to pursue.
Possible Complications When Diagnosed with Esophageal Diverticula
Although complications from esophageal diverticula are unusual, they do occur. These complications can be serious and include blockage of the esophagus, rupture or perforation of the esophagus, and a type of esophageal cancer called squamous cell carcinoma.
Potential Complications:
- Blockage of the esophagus
- Rupture or perforation of the esophagus
- Squamous cell carcinoma, a type of esophageal cancer
Recovery from Esophageal Diverticula
After surgery, certain problems could arise, including bleeding, hematoma (a build-up of blood outside of the blood vessels), infection, or the esophagus leaking at the repaired site. Other possible complications may include the formation of unusual connections between organs (fistulas), infection within the space between the lungs (mediastinal infection), puncture of the esophagus (esophageal perforation), or narrowing of the esophagus (esophageal stenosis). There’s also a chance of damaging the recurrent laryngeal nerve, a nerve that plays a key role in speaking and swallowing, and the development of air in the area between the lungs (pneumomediastinum).
The likelihood of these complications happening largely depends on the method of surgery or endoscopy used and the expertise of the surgeon.
