An esophageal diverticula is an outward protrusion of the esophagus . They are divided into three groups. The clinical picture, course, diagnosis, treatment and prevention are described below.
What is an esophageal diverticula?
Esophageal diverticula are a rather rare disease. Older men are mostly affected. This causes the wall of the esophagus to protrude outwards.
Esophagus comes from the Greek and means “the food bringer” and thus stands for the esophagus. Diverticulum comes from the Latin and means way or deviation. In this clinical picture, a distinction is made between “false” and “real” diverticula. For radius fracture definition and meaning, please visit howsmb.com.
If only a mucosal prolapse occurs, if only the mucous membrane turns outwards, this is referred to as a false diverticulum. If, on the other hand, all layers of the esophageal wall are affected by the bulge, doctors call this a real diverticulum. Diverticula are localized and can vary in size. They arise at the physiological constrictions of the esophagus, i.e. in the upper, middle and lower third.
Esophageal diverticula can occur throughout life or are congenital. They develop as a result of increased pressure in the hollow organ or as a result of external traction, which causes the tissue to give way and a diverticulum to develop.
A distinction is made between pulsion diverticula and traction diverticula. Pulsion diverticula are manifested by excessive pressure in the esophagus and weakness in the esophageal wall. The mucous membrane bulges, usually in the upper third of the esophagus.
This type of diverticula is named after the Dresden pathologist Friedrich Albert von Zenker. In addition to the Zenker diverticulum, it is also called the hypopharynx or cervical diverticulum. The pulsation diverticula also include the epiphrenic diverticula that develop in the lower third.
Traction diverticula are created by external traction. These are often inflammatory lymph nodes that are present in adjacent tissue. The type of esophageal diverticula occur predominantly in the middle region of the esophagus. They are also called epibronchial or parabronchial diverticula because of their proximity to the main bronchi.
Symptoms, Ailments & Signs
The symptoms of esophageal diverticula depend on the type and location of the bulges. The pulsation diverticula cause more severe symptoms than the traction diverticula. In the case of pulsation diverticula, a distinction can be made between the symptoms of Zenker’s diverticula and those of epiphrenic diverticula.
Zenker’s diverticulum in the upper part of the esophagus initially begins with such symptoms as a sore throat, constant foreign body sensation in the throat and chronic clearing of the throat. The symptoms increase over time. The bulging of the esophagus below the pharynx is slowly getting bigger and causes increasing difficulty in swallowing, which is particularly noticeable when eating solid food.
A gurgling sound occurs when drinking. Since the chyme is no longer transported and accumulates in the bulge, there is permanent bad breath and constant belching. When lying down at night, chyme can get into the oral cavity and from there to the outside. Food leftovers are often discovered on the pillow in the morning.
The epiphrenic diverticula found in the lower part of the esophagus produce less specific symptoms that can also indicate other diseases. This often leads to a backflow of stomach acid into the esophagus, which leads to severe heartburn and pain behind the breastbone. In addition to swallowing difficulties, leftover food can also get into the oral cavity when lying down. The parabronchial traction diverticulum, on the other hand, is usually symptom-free. Coughing can occur with inflammation.
Diagnosis & History
Zenker ‘s diverticulum occurs with a frequency of 70%. Symptoms tend to develop gradually over time. Affected people usually suffer from a sore throat, frequent clearing of the throat and a foreign body sensation. Difficulty swallowing solid food and a gurgling noise when drinking liquid can also occur. Many patients also experience bad breath and belch up bits of food that remain in the diverticulum.
Epiphrenic diverticula tend to trigger unspecific symptoms, such as pain in the upper abdomen, nocturnal pressure pain behind the breastbone and difficulty swallowing.
Symptoms are rare in parabronchial diverticula. The diverticula are often discovered incidentally during X-ray examinations. All three types can cause esophagitis and gastroesophageal reflux disease through food retention in the diverticula. Furthermore, it can lead to so-called regurgitations, with leftover food being pushed up, especially when lying down. This creates an aspiration risk as the food particles can be inhaled.
If a diverticula is suspected, an X-ray examination is ordered. Using a barium sulfate solution, remaining solution in the diverticulum can be detected under X-ray inspection. A reflection of the esophagus is usually only performed to rule out tumors.
Esophageal diverticula have a very good prognosis after treatment. However, if left untreated, serious complications can occur. The greatest risks for a complicated course exist with the so-called Zenker diverticulum. It is a pulsation diverticula in the upper part of the esophagus.
These diverticula must be surgically removed because otherwise life-threatening complications can develop. The remains of food left in the sac irritate the esophagus. Inflammation occurs, which can even lead to esophageal bleeding. In some cases, the esophagus even perforates. Food residues can flow back out of the diverticulum, especially at night when lying down.
When inhaled, these enter the trachea and from there also the lungs. There is a risk of suffocation. At the same time, the leftover food can cause pneumonia or lung abscesses. The epiphrenic diverticula, which occur at the bottom of the esophagus, also often lead to esophagitis. In addition, stubborn gastroesophageal reflux can develop, which triggers chronic heartburn and increases the risk of esophageal cancer.
To a lesser extent, food residue can also get into the throat and windpipe here, which then causes suffocation attacks or pneumonia. The parabronchial diverticula are located in the middle of the esophagus and usually do not cause any symptoms. In very rare cases, however, connections (fistulas) to the trachea can form, so that the food particles can also penetrate the airways here and lead to the corresponding life-threatening complications.
When should you go to the doctor?
Esophageal diverticula can be congenital or develop over the course of life. In the case of a congenital disorder, the first health irregularities are usually noticed within the first few days after birth. If there are irregularities in the food intake, consultation with a doctor is necessary. If the disease develops in the course of life, there is usually an increase in symptoms over a longer period of time. Difficulty swallowing, loss of appetite, and refusal to eat are among the health concerns that may arise and need to be investigated. Changes in speech, pain, or a general feeling of being unwell should be presented to a doctor.
If the usual food can no longer be transported through the throat into the esophagus without symptoms, a doctor’s visit is required. A decrease in body weight and a feeling of internal dryness need to be evaluated and treated. If left untreated, it can lead to serious health consequences, as dehydration can occur when refusal to drink enough water. This is a life-threatening condition that requires immediate medical attention. Heartburn, chest pain, or irregular coughing should be reported to a doctor. In rare cases, there are also disturbances in breathing or a feeling of tightness.
Treatment & Therapy
The treatment of the Zenker diverticulum and the epiphrenic diverticulum is surgical. The esophagus is exposed and the existing diverticulum is removed. This treatment is called diverticulopexy.
In the case of a Zenker diverticulum, there is also the option of minimally invasive removal through the oral cavity. Parabronchial diverticula are surgically removed only when absolutely necessary.
In patients suffering from an epiphrenic diverticulum, first attempt is made to relieve symptoms by eating small meals and avoiding large amounts of alcoholic, fatty and acidic foods as well as chocolate. Medications for reflux disease that may occur can also reduce symptoms.
Preventing an oesophageal diverticulum is not explicitly possible. However, a balanced diet and small portions are easy on the digestive tract and thus reduce the risk of developing a diverticulum.
You can do that yourself
If the doctor has prescribed conservative therapy, its success requires the active participation of the patient. In order to reduce the reflux of gastric juice into the esophagus, an adjustment in diet is necessary. Anyone who has been eating the usual three large meals should first switch to five to six smaller meals. It is also important to eat the right things and avoid counterproductive foods.
All foods that strongly stimulate gastric juice production are harmful. These include, first and foremost, very fatty foods. In particular, red meat, sausage, fatty cheese, butter and cream should be avoided. Most of those affected also react to sugar and desserts with increased gastric juice production. In this case, such foods may only be consumed in exceptional cases. In addition, tea is usually more digestible than coffee. If you don’t want to do without breakfast coffee, you can switch to grain-based products. Spelled coffee is particularly tasty and easily digestible.
In addition, alcohol should be avoided, especially in the form of highly acidic or high-proof drinks. The consumption of acidic foods usually has an unfavorable effect on the esophageal diverticulum. On the other hand, whole grain products, vegetables and non-acidic fruit, especially bananas, are recommended. If there is a backflow of gastric juice or leftover food, especially at night, an upright sleeping position can also provide relief.