Esophageal Diverticula

Symptomatic patients require upper esophageal myotomy and, in most cases, surgical diverticulectomy. Significant improvement occurs in over 90% of patients treated surgically. Small asymptomatic diverticula may be observed. An intraluminal (endoscopic) approach has been developed recently in which the septum between the esophagus and diverticulum is incised.

Difficulty when swallowing is the sensation that food is stuck in the throat or upper chest. As is common practice, Zenker diverticulum, a type of diverticulum that arises from the posterior hypopharynx, is also discussed in this article. Esophageal diverticula are weak parts of the esophagus that pouch outward. small proportion may present with life-threatening bleeding Pressures in the lower esophagus and lower esophageal sphincter in patients with lower esophageal diverticulum and motor disturbance were the same as for those in matched patients with motor disturbances but no diverticulum Finally, acquired diverticula of the esophagus and hypopharynx also may be classified according to their pathogenesis as pulsion diverticula or traction diverticula Dysphagia, chest pain and regurgitation were common presenting symptoms. Of 46 patients with dysphagia, only ten had mechanical obstruction to explain this symptom. An epiphrenic diverticulum occurs from increased pressure during esophageal propulsive contractions against a closed lower esophageal sphincter. False diverticula, also known as pseudodiverticula, occur when herniation of mucosa and submucosa through a defect in the muscular wall occurs (eg, Zenker diverticulum). The diverticulum itself is usually not the sole cause of the esophageal symptoms, although diverticula can produce symptoms in the absence of other definable conditions Specific types of diverticula occur at the top, middle, and bottom of the esophagus. In contrast, traction diverticula occur as a consequence of pulling forces on the outside of the esophagus from an adjacent inflammatory process (eg, involvement of inflamed mediastinal lymph nodes in tuberculosis or histoplasmosis).

The esophagus connects the mouth to the stomach. Congenital diverticula are diverticula that are present at birth, while acquired diverticula develop later in life. Of the 15 patients with normal esophageal motility, 13 had hiatal hernia, and five of these had a high grade distal esophageal stricture. Pressures in the lower esophagus and lower esophageal sphincter in patients with lower esophageal diverticulum and motor disturbance were the same as for those in matched patients with motor disturbances but no diverticulum. diverticulum occurs due to increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter. We conclude that the development of lower esophageal diverticulum and its symptoms are associated with a motor disturbance of the esophagus in the majority of patients and with an organic obstruction in the minority of patients. This may be felt high in the neck or lower down, behind the breastbone (sternum). When surgical treatment is indicated, the diverticulum should be excised and the underlying motor or mechanical obstruction should be corrected to prevent serious postoperative complications and recurrence of the diverticulum and its symptoms

Causes of Esophageal Diverticula

The common causes of Esophageal Diverticula :-

• Structural lesions, including a noncompliant cricopharyngeus muscle (ie, Zenker diverticulum), incomplete or uncoordinated relaxation of the lower esophageal sphincter, or strictures, may play a role as well.
• An underlying inflammatory process within the mediastinum has been associated with mid esophageal diverticula.
• Emotional or anxiety disorder (globus hystericus)
• Enlarged veins (varices) at the lower end of the esophagus may rupture and bleed massively.
• Strictures (narrowings) that may be caused by radiation, chemical ingestions, medications, or ulcers
• Infections with Helicobacter pylori (H. pylori), alcohol, aspirin, aspirin-containing medicines, and various other medicines (NSAIDs, particularly those used for arthritis) can cause stomach ulcers or inflammation ( gastritis ).

Symptoms of Esophageal Diverticula

Some are common symptoms of Esophageal Diverticula :-

• Food regurgitation on lying down
• Bad breath
• Very hot or cold liquids may aggravate the pain.

Treatment of Esophageal Diverticula

• In many patients with mid esophageal and epiphrenic diverticula, dysphagia is related to underlying dysmotility; thus, treatment should be directed to the motility disorder when feasible. For instance, achalasia can be treated with pneumatic dilation, botulinum toxin injection into the lower esophageal sphincter, or surgical Heller esophagomyotomy
• Based upon an analysis of clinical findings, literature data and personal experiences the authors consider that the main method of treatment of esophageal diverticula of greater size or complicated by bleedings, malignization, esophagitis and diverticulitis is diverticulectomy with the autotissue plasty.
• Diverticulectomy usually is not performed by itself because it does not correct the defect in cricopharyngeal function that usually contributes to the formation of a Zenker diverticulum.
• While the transcervical approach has been used traditionally, the transoral route using a rigid esophagoscope also may be used.

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