What is Oesophageal Diverticulum?

Oesophageal diverticulum refers to an abnormal pouch or sac that forms in the wall of the esophagus. These pouches can trap food or fluids, leading to swallowing difficulties and other symptoms. Diverticula (plural for diverticulum) may develop at different levels of the esophagus and are classified based on their location:

• Zenker’s diverticulum – forms in the upper esophagus
• Mid-esophageal diverticulum – occurs in the middle portion
• Epiphrenic diverticulum – located near the lower esophagus, just above the diaphragm

Oesophageal diverticula are relatively rare and may be asymptomatic or cause significant discomfort depending on their size and location.

What causes Oesophageal Diverticulum?

The development of oesophageal diverticula can be due to increased pressure inside the esophagus or abnormalities in the muscle wall. Causes vary by type:

• Zenker’s diverticulum:
  • Caused by increased pressure in the throat during swallowing
  • Often due to muscle dysfunction or weakness at the cricopharyngeal muscle (upper esophageal sphincter)
• Mid-esophageal diverticulum:
  • Usually associated with underlying conditions like tuberculosis, fungal infections, or esophageal motility disorders
• Epiphrenic diverticulum:
  • Commonly caused by motility disorders such as achalasia or diffuse esophageal spasm, leading to abnormal pressure buildup

Additional contributing factors may include:

• Chronic gastroesophageal reflux disease (GERD)
• Age-related degeneration of esophageal muscles
• Congenital structural weakness in the esophagus

What are the symptoms of Oesophageal Diverticulum?

Some individuals may not experience any symptoms, especially if the diverticulum is small. When symptoms do occur, they may include:

• Difficulty swallowing (dysphagia)
• Regurgitation of undigested food
• Chronic cough or throat clearing
• Bad breath (halitosis) due to trapped food
• Chest pain or discomfort
• Hoarseness
• Aspiration of food into the lungs, leading to pneumonia or coughing fits

Symptoms often worsen over time, particularly if the pouch enlarges.

How is Oesophageal Diverticulum diagnosed?

Diagnosis typically involves a combination of imaging and endoscopic procedures:

• Barium swallow (esophagram): This X-ray test involves drinking a contrast liquid that highlights the esophagus. It clearly shows the size and position of the diverticulum.
• Endoscopy (EGD): A flexible tube with a camera is inserted into the esophagus to directly visualize the diverticulum and rule out other conditions.
• Esophageal manometry: Measures the muscle function of the esophagus to identify any underlying motility disorders.
• CT scan: May be used in some cases to evaluate the esophagus and surrounding structures.

What are the treatment options for Oesophageal Diverticulum?

Treatment depends on the type, size, and severity of symptoms. Options include:

• Observation: Small diverticula that are not causing symptoms may simply be monitored over time.
• Dietary changes:
  • Eating slowly and chewing thoroughly
  • Drinking water with meals to help wash down food
  • Avoiding sticky or dry foods
• Medications:
  • Proton pump inhibitors (PPIs) may be used to treat associated GERD or inflammation
• Endoscopic treatment:
  • Minimally invasive techniques may be used for Zenker’s diverticulum, including endoscopic stapling or myotomy to cut the muscle and open the pouch.
• Surgical treatment:
  • Diverticulectomy: Removal of the diverticulum
  • Myotomy: Cutting the muscle to relieve pressure and improve swallowing
  • Diverticulopexy: Suspending or repositioning the pouch instead of removing it

Surgery may be required for larger diverticula or when symptoms are severe or complications occur, such as aspiration pneumonia.

What is the prognosis for Oesophageal Diverticulum?

With appropriate treatment, most individuals experience significant improvement in symptoms. Endoscopic and surgical procedures are generally effective, especially for Zenker’s and epiphrenic diverticula.

If left untreated, complications may include:

• Repeated aspiration leading to lung infections
• Malnutrition due to poor intake
• Esophageal inflammation or ulceration
• Rarely, cancer can develop within a longstanding diverticulum (especially Zenker’s)

Early diagnosis and treatment can help prevent these complications and improve quality of life.

Can Oesophageal Diverticulum be prevented?

There is no guaranteed way to prevent oesophageal diverticula, especially since some causes are related to aging or underlying disorders. However, managing esophageal motility problems and avoiding excessive straining during swallowing may reduce the risk.

Prompt treatment of conditions like GERD or achalasia may also help prevent secondary diverticulum formation.

How can patients and families cope with Oesophageal Diverticulum?

Coping strategies include:

• Following dietary recommendations to minimize symptoms
• Adhering to prescribed medications
• Seeking medical advice early if symptoms worsen or new issues arise
• Attending follow-up appointments to monitor the condition
• Joining support groups for individuals with swallowing or digestive disorders

With proper care and lifestyle management, people with oesophageal diverticulum can maintain a good quality of life.