Esophageal diverticula
An esophageal diverticulum is an epithelial-lined mucosal pouch that protrudes from the esophageal lumen.
Esophageal diverticula are classified according to their location: just above the upper esophageal sphincter (Zenker’s, or pulsion, diverticulum is the most common type), near the midpoint of the esophagus (traction diverticulum), and just above the lower esophageal sphincter (epiphrenic diverticulum).
Esophageal diverticula are classified according to their location: just above the upper esophageal sphincter (Zenker’s, or pulsion, diverticulum is the most common type), near the midpoint of the esophagus (traction diverticulum), and just above the lower esophageal sphincter (epiphrenic diverticulum).
Generally, esophageal diverticula occur later in life, although they can affect infants and children. They’re three times more common in men than in women. Zenker’s diverticula occur in patients ages 30 to 50.
Causes
Esophageal diverticula are caused by either primary muscle abnormalities that may be congenital or inflammatory processes adjacent to the esophagus.
Zenker’s diverticulum
When the pouch results from increased intraesophageal pressure, Zenker’s diverticulum occurs. It’s caused by developmental muscle weakness of the posterior pharynx above the border of the cricopharyngeal muscle. The pressure of swallowing aggravates this weakness, as does contraction of the pharynx before relaxation of the sphincter.
Traction diverticulum
When the pouch is pulled out by adjacent inflamed tissue or lymph nodes, a midesophageal (traction) diverticulum occurs. It’s a response to scarring and pulling on esophageal walls by an external inflammatory process such as tuberculosis. It’s diagnosed as an incidental finding on a barium esophagogram and is usually asymptomatic. No specific treatment is indicated.
Epiphrenic diverticulum
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