Esophageal Diverticulum Overview

An esophageal diverticulum is an abnormal pocket-like structure that forms in the esophagus, a tubular organ that carries food from the mouth to the stomach. The pocket develops when a portion of the inner mucosal lining pushes through the outer muscular wall. The condition is classified based on its site of origin within the esophagus.

The types of esophageal diverticulum include:

• Zenker's diverticulum – Located at the top of the esophagus near the throat (most common)
• Midthoracic (Rokitansky) diverticulum – Located in the middle region of the esophagus in the chest
• Epiphrenic diverticulum – Located at the end of the esophagus near the stomach

Overall, esophageal diverticula are relatively rare.

Esophageal Diverticulum Causes and Risk Factors

An esophageal diverticulum can form if excessive pressure builds up within the esophagus. The pressure may be caused by a swallowing disorder, such as achalasia, which occurs when the esophageal muscles do not contract sufficiently to propel food toward the stomach. Increased pressure can also result from chronic esophageal obstruction due to a narrowing (stricture) or tumor.

Another possible cause of an esophageal diverticulum is a weakness in the esophageal wall, which may be present at birth (congenital) or acquired through trauma.

Esophageal Diverticulum Signs and Symptoms

The first noticeable sign of an esophageal diverticulum is usually difficulty swallowing (dysphagia), which may create a sensation that food is getting caught in the throat instead of passing down to the esophagus.

What Does an Esophageal Diverticulum Feel Like?

In addition to dysphagia, other symptoms of an esophageal diverticulum can include:

• Painful swallowing
• Regurgitation of undigested food
• Chronic coughing
• Bad breath (halitosis)
• Neck or chest pain
• Gurgling sounds (Boyce’s sign) that occur when air passes the diverticulum

Additionally, due to aspiration of food, some individuals experience unintended weight loss and recurrent respiratory infections.

What Does an Esophageal Diverticulum Look Like?

In an imaging test, such as a barium swallow X-ray or gastrointestinal endoscopy, an esophageal diverticulum may look like a pocket protruding from the esophageal wall. The pocket, which can vary in size and location, may contain food particles or fluid.

Esophageal Diverticulum Diagnosis

The diagnostic process for an esophageal diverticulum may include:

• Barium swallow X-ray – While the patient swallows a barium contrast agent in the form of a chalky drink, a radiologist will capture a series of X-rays of the esophagus. The contrast agent will enhance the visibility of the esophageal diverticulum (if present) in the images.
• Gastrointestinal endoscopy – A physician will guide a thin, flexible tube with a miniature camera attached to the end (endoscope) through the mouth, down the throat and into the esophagus. Using the endoscope, the physician can directly visualize the esophageal diverticulum (if present) and assess its size and location.
• Esophageal manometry – A physician will pass a thin, flexible catheter with pressure sensors at the tip through a numbed nostril, guiding it down the throat, through the esophagus and into the top of the stomach. Once the catheter is in place, the attached sensors will measure the timing and strength of the esophageal muscle contractions while the patient swallows.
• 24-hour acidity (pH) monitoring – A physician will pass a thin, flexible catheter with pH sensors attached to the tip through the mouth or a numbed nostril, guiding it down the throat and through the esophagus until it reaches the stomach. The tube will remain in place for 24 hours while the attached sensors record the pH levels in the esophagus.

Esophageal Diverticulum Treatment

Treatment for an esophageal diverticulum can vary based on its size and location and the severity of the symptoms. In mild cases, lifestyle changes and dietary modifications may be sufficient, such as:

• Consuming a bland diet
• Eating smaller, more frequent meals
• Avoiding foods that worsen the symptoms
• Thoroughly chewing food
• Drinking plenty of water, especially after eating

In severe cases, or if complications arise, surgical intervention may be considered to relieve the esophageal obstruction. Surgical treatment techniques for an esophageal diverticulum include:

• Cricopharyngeal (CP) myotomy – A surgeon will separate the CP muscle to improve swallowing function, promote the passage of food, reduce pressure within the esophagus and prevent the formation of new diverticula.
• Diverticulopexy – To prevent the diverticular pocket from collecting food, a surgeon will reposition it and secure it to the esophageal wall with sutures.
• Diverticulectomy – After making an incision in the neck, a surgeon will separate the CP muscle and remove the entire diverticulum.

To enhance the treatment outcome, CP myotomy may be performed in conjunction with diverticulopexy or diverticulectomy.

Benefit From World-Class Care at TGH

Tampa General Hospital’s Digestive Diseases Institute is home to a multidisciplinary team that specializes in preventing, diagnosing and treating conditions of the gastrointestinal (GI) tract, including esophageal diverticula. Through ongoing research and clinical trials, we remain firmly positioned on the leading edge of gastroenterology and GI surgery, and we offer the most advanced diagnostic and treatment options available today.

If you would like to be referred to a physician in TGH’s GERD and Esophageal Surgery Center, please call 1-800-822-3627 or use our online Physician Finder.