Dorothy FarrarEsophageal diverticula (esophageal diverticula)
Esophageal diverticulum (esophageal diverticulum) is a protuberance of the esophagus, and a total of three groups can be distinguished.
What is an esophageal diverticula?
In general, a diverticulum is a sac, pear, or mushroom-shaped protuberance that can be found on the wall of the intestine , bladder , or esophagus . Esophageal diverticula are rare and mainly affect older men. As part of the disease, the wall of the esophagus turns outwards. A distinction can be made between “real” and “false” diverticula. A false diverticulum refers to a mucosal prolapse that turns outwards. However, if the protuberance affects all layers of the esophagus, this is referred to as a true diverticulum. Diverticula can vary in size and occur in either the lower, middle, or upper third of the esophagus.
causes
Esophageal diverticula are either congenital or develop throughout life. The reason for this is either increased pressure in the hollow organ or a tensile force acting from the outside. As a result, the tissue gives way and a diverticulum can develop. A basic distinction is made between so-called traction diverticula and pulsion diverticula. Pulsion diverticula occur because of excessive pressure in the esophagus or weakness of the esophageal wall where the mucosa becomes bulged. This form of diverticulum is also known as a Zenker diverticulum, cervical diverticulum, or hypopharyngeal diverticulum.
In Zenker’s diverticulum, the function of the upper esophageal sphincter is disturbed. Normally, the muscle opens and closes correctly, allowing the chyme to enter the esophagus. However, in this form of diverticulum, the muscle closes prematurely, causing pressure to build up in the lower part of the throat. In addition, there is a natural weak point at the back of the esophagus. Here the muscle fibers of the esophagus and throat run differently and form the so-called Kilian muscle gap. By swallowing, a very high pressure is built up here, whereby the mucous membrane is pressed through the gap and turned outwards. Over time, the diverticulum grows, displacing the tissue and pushing the esophagus forward.
Another reason for the development of a diverticulum can be a disturbance in the swallowing process. However, constrictions that can occur in the lower section of the esophagus also play a role here. As a result, leftover food builds up when swallowing and puts pressure on the lower wall of the esophagus. External traction causes traction diverticula to form. This refers to inflammatory lymph nodes that can be found in the adjacent tissue. This form occurs mainly in the middle of the esophagus and is also known as the terminus parabronchiales or epibronchial diverticulum because it is close to the main bronchi.
symptoms and course
Typical symptoms:
Normally, parabronchial diverticula do not cause any symptoms. Coughing or swallowing problems are rare. This form is usually discovered by chance during an X-ray examination . If an epiphrenal diverticulum is present, those affected suffer from swallowing difficulties and abdominal pain as well as heartburn, since leftover food flows back into the oral cavity.
A Zenker’s diverticulum causes a scratchy throat, sore throat, difficulty swallowing, bad breath or heartburn. There may also be a gurgling sound when liquid is ingested. Many of those affected also throw up the remains of the food they have eaten, as these remain in the diverticulum. Since food residues remain in the protuberances in all forms, esophagitis or so-called reflux disease can occur.
Diagnose
First, the doctor collects the medical history, whereby the age and the symptoms can give a first indication of whether a diverticulum may have formed on the wall of the esophagus. If there is a suspicion of an esophageal diverticulum, the doctor will carry out an X-ray examination. With the help of a barium sulfate solution, he can then determine whether a diverticulum is present. To do this, patients have to swallow a water-soluble contrast agent that is later excreted from the body.
In the X-ray image, the agent – in contrast to the tissue – appears white. If there is a bulge in the esophagus, it is filled with the agent and can then be seen as a white bulge on the X-ray image. Dynamic video fluoroscopy is often performed to check whether any movement disorders are the cause of the esophageal diverticulum. The swallowing process is recorded with X-rays. An esophageal endoscopy is only ordered to rule out a possible tumor .
treatment and therapy
An epiphrenic diverticulum or a Zenker diverticulum is treated surgically. This involves exposing the esophagus so that the diverticulum can then be removed. This form of treatment is called diverticulopexy.
A Zenker diverticulum can also be removed minimally invasively through the oral cavity; parabronchial diverticula only need to be treated if it appears absolutely necessary. In patients suffering from an epiphrenic diverticulum, the symptoms are initially relieved by avoiding acidic, fatty or alcoholic foods.
prevention
Esophageal diverticula cannot be prevented, but a balanced diet can reduce the risk of developing a diverticulum.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.