Esophageal Diverticula

What are Esophageal Diverticula?

The esophagus connects the mouth to the stomach. Esophageal diverticula are weak parts of the esophagus that pouch outward. Specific types of diverticula occur at the top, middle, and bottom of the esophagus.

Symptoms of Esophageal Diverticula

Pouches in the neck usually cause bad breath (halitosis) and the regurgitation of swallowed food and saliva. Some patients with diverticula can push on their neck and make old food appear in their mouth. Pouches near the stomach may cause swallowing problems, conditions known as achalasia or dysphagia. Mid-esophageal pouches usually cause no symptoms.

In the most serious cases, a person may be unable to swallow because the esophagus is obstructed, or the esphagus may rupture, spilling its contents into the chest or neck.

Causes of Esophageal Diverticula

To propel food into the stomach (or out of it during vomiting) the esophagus generates internal pressure just like the bowel. Under certain circumstances, that pressure can herniate the esophageal lining through a weakness in the wall, creating a pouch. Food and saliva can collect in all of these pouches. Pouches are more common in people who have motor disorders of the esophagus.

Diagnosing Esophageal Diverticula

Difficulty swallowing, bad breath, or food reappearing in the back of the mouth are among the signs physicians look for when diagnosing this condition. Sometimes the patient may also experience pain in the chest resembling a heart attack. A series of x-rays taken while swallowing a contrast agent usually identifies the diverticulum clearly. An esophagoscopy may also be needed to gather more detail. Manometry, measuring pressures inside the esophagus using a balloon that is passed down it, may help determine the cause of the diverticula.

Treating Esophageal Diverticula

Treatment for this condition is primarily aimed at alleviating symptoms. Physicians direct the patient to eat a bland diet, to chew his or her food thoroughly, and to drink water after eating to clean out the pouches. If the condition is severe, several types of surgery are available to remove the pouches and repair the defects. If a pouch is due to a stenosis (narrowing) in the esophagus, it may be possible to relieve it by passing a dilator through it, a process called bougeinage.