Esophageal diverticula

Last updated: September 28, 2022

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Esophageal diverticula are abnormal pouches that arise from the wall of the esophagus. They most commonly occur in middle-aged and older men and are classified based on localization, pathophysiology, and histological findings. The most common type of esophageal diverticula is Zenker diverticulum, which extends posteriorly in the hypopharynx directly proximal to the upper esophageal sphincter. Esophageal diverticula can be caused by either an underlying motility disorder that exerts high intraluminal pressures on a weak esophageal wall or from forces pulling on the outside of the esophagus. The clinical presentation varies with pouch size and localization, with the most common symptoms being dysphagia, regurgitation, retrosternal pain, and pulmonary symptoms secondary to aspiration. The diagnosis is confirmed by barium swallow, which also aids in determining the size of the diverticulum and potential malignancy. Surgical treatment is rarely required and only recommended in symptomatic patients (primarily those with Zenker diverticula).

  • Rare diverticula compared to other gastrointestinal sites [1]
  • Peak incidence: middle-aged and older male individuals [2]
  • Zenker diverticulum is the most common type. [3]

Epidemiological data refers to the US, unless otherwise specified.

Esophageal diverticula are classified according to their localization, histology, and pathophysiology. [1]

Localization

Zenker diverticulum arises from the hypopharynx, although it is classified as an esophageal diverticulum.

Histology

Pathophysiology

Clinical presentation depends on diverticulum size and localization. [1][4]

Elder MIKE has bad breath: Elderly, Male individuals, Inferior pharyngeal constrictor, Killian triangle, Esophageal dysmotility, halitosis.

Diverticula of the middle and distal esophagus rarely require any treatment since most of them are asymptomatic. [1]

We list the most important complications. The selection is not exhaustive.

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