Diverticulum of the esophagus (esophageal diverticulum)

Esophageal diverticulum refers to saccular protuberances in confined areas of the esophageal wall. Esophageal diverticulum may be congenital or acquired, as well as distinguishing true diverticula from pseudodiverticula. There are typical symptoms that do not necessarily occur. Men of higher age are more frequently affected, and diverticula in the feeding tube are more of a rarity in people under the age of 40 years. Diverticula occur frequently in the colon next to the esophagus, so-called colonic diverticulum or diverticulosis. In principle, however, the entire digestive tract can be affected.

contents

• The esophagus
• "Real" and "wrong" diverticula
• Symptoms and complications of Zenker's diverticulum
• diagnosis
• Symptom relief and therapy

The esophagus

The esophagus is the thumb thickness, about 25 cm long tube-like connection between throat and stomach. The muscle tube is located between the spine and trachea and leads through the so-called Larray column down through the diaphragm, where it passes into the stomach. The esophagus consists of three wall layers:

• the outer muscle layer,
• a connective tissue shift layer and
• the mucous membrane inside the organ.

In these layers it comes from the inside out to the Aussackungen, which can be thought of as "indentations" in the mucous membrane.

The Zenker's diverticulum is the most common diverticulum disease in the esophagus (Image: ellepigrafica / fotolia.com;

"Real" and "wrong" diverticula

In feeding tube diverticula a distinction is made between two different forms of protuberance in the esophagus. In pulsion diverticulum, the protuberance is created by a mismatch of internal pressure and wall stability. If the diverticulum forms by an external tension, for example by a scar after an inflammation, it is a traction diverticulum.

A distinction is also made between true diverticula in which all wall layers are affected by the protuberances and pseudodiverticles, which are merely mucosal protuberances through muscle gaps.

Symptoms and complications of Zenker's diverticulum

Most commonly (in about 70 percent of those affected) so-called Zenker pulse diverticula occur, which means that pseudodiverticles have formed in the upper area of ​​the esophagus. Typical symptoms of Zenker Pulsion diverticula include:

• Dysphagia with pressure sensation behind the breastbone and
• This triggers a foreign body sensation in the throat,
• bad breath (foetor ex ore) as well as
• Cough irritation that occurs directly after ingestion.

However, in the case of an esophageal diverticulum, typical cardinal symptoms are a gargling sound when drinking and leftovers on the pillow that occasionally strike in the morning.

Complications can occur when backflowing food particles enter the airways. Then it can come to a pneumonia (aspiration pneumonia). In addition, inflammation (diverticulitis) can result, leading to perforation, i. lead to the breakthrough of the esophageal wall.

diagnosis

There are three different methods to diagnose a diverticulum in the esophagus and to clarify the nature and extent of the protuberance and thus determine the treatment method:

• Esophageal Bliss Luck, a contrast agent-assisted imaging technique,
• Manometry to perform a pressure measurement within the esophagus or
• an endoscopic examination (but rarely used because of possible injuries).

Esophageal endoscopy is rarely used in diagnosis, but often in surgical removal of the diverticulum (Image: romaset / fotolia.com)

Symptom relief and therapy

So far, conventional therapy has been surgical removal of the esophageal diverticulum. Depending on the severity of the disease and the location of the diverticulum, open surgery is necessary or endoscopic.

In order to alleviate the symptoms until surgery, it is advisable to eat several small meals throughout the day and to avoid foods that can lead to gastric acid reflux into the esophagus, such as:

• alcohol,
• sour food,
• greasy food and
• Sweets.

(fp, ok, updated on 26.04.2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)