eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Diverticula: Differential Diagnoses & Workup

Author: Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine
Coauthor(s): Christopher (Kit) Bartalos, DO, Fellow, Department of Gastroenterology, University of Missouri at Columbia; Rodney A Perez, MD, Medical Director, The Endoscopy Center, Asheville Gastroenterology Associates; Consulting Staff, Department of Gastroenterology, Mission St Joseph's Hospital; John B Marshall, MD, Professor, Department of Internal Medicine, Division of Gastroenterology, University of Missouri School of Medicine
Contributor Information and Disclosures

Updated: Sep 2, 2008

Differential Diagnoses

Achalasia
Gastroesophageal Reflux Disease
Esophageal Cancer
Zenker Diverticulum
Esophageal Motility Disorders
Esophageal Spasm
Esophageal Stricture

Workup

Laboratory Studies

  • Most laboratory studies are not helpful in the diagnosis. (Upper esophageal webs have been associated with iron deficiency anemia.)

Imaging Studies

  • Radiographic studies and upper GI endoscopy detect many esophageal diverticula incidentally because esophageal diverticula often are asymptomatic.
  • On standard chest radiographs and CT scans, large diverticula of the esophagus and hypopharynx also may manifest as air-filled and/or fluid-filled structures communicating with the esophagus.
  • Barium radiography (ie, barium esophagography, barium swallow) generally is the diagnostic procedure of choice. In addition to being excellent at defining the structural appearance of diverticula, barium swallow also may provide clues to underlying motility disturbances that may be involved in diverticular formation. However, if the patient has dysphagia or odynophagia or has alarm symptoms, then upper endoscopy is indicated.
    • Barium swallow is a useful study in patients who are symptomatic and have mid esophageal and epiphrenic diverticula.
    • Diagnosis of esophageal intramural pseudodiverticulosis is made best using barium radiography.
    • Diagnosis of Zenker diverticulum is made best using barium swallow, which should include lateral views of the pharyngoesophageal junction. It also can be made using careful upper endoscopy by an experienced endoscopist.

Other Tests

  • Esophageal manometry can be helpful to evaluate lower esophageal sphincter pressure, lower esophageal sphincter relaxation, and esophageal body function in symptomatic patients if achalasia or another esophageal motility disorder is suspected or if surgery is being considered. It can also demonstrate the incoordination between the buccal squirt and relaxation of the cricopharyngeus, although special manometric techniques are usually required. In patients with dysphagia, esophageal manometry is helpful to better define underlying motility disorders.

Procedures

  • Perform esophagogastroduodenoscopy to rule out structural conditions of the esophagus, such as strictures or neoplasms, that have been associated with esophageal diverticula.
  • Flexible endoscopy is a useful study in patients who are symptomatic and have mid esophageal and epiphrenic diverticula.
    • Endoscopy is unnecessary in a patient with Zenker diverticula if the diagnosis has been made using barium radiograph.
    • If flexible upper GI endoscopy is needed in a patient with a known Zenker diverticulum, it should be performed with caution, with the endoscope being passed under direct visualization to minimize the risk of perforation.

More on Esophageal Diverticula

Overview: Esophageal Diverticula
Differential Diagnoses & Workup: Esophageal Diverticula
Treatment & Medication: Esophageal Diverticula
Follow-up: Esophageal Diverticula
Multimedia: Esophageal Diverticula
References
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References

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Further Reading

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Keywords

esophageal diverticula, esophageal diverticulum, Zenker diverticulum, Zenker's diverticulum, pharyngoesophageal diverticula, hypopharynx, congenital esophageal diverticulum, acquired esophageal diverticulum, diverticulum of the esophageal body, true esophageal diverticula, false esophageal diverticula, pseudodiverticula of the esophagus, esophageal intramural pseudodiverticulosis, pulsion diverticula of the esophagus, traction diverticula of the esophagus, dysphagia, epiphrenic diverticula, regurgitation, nocturnal cough, aspiration pneumonia, Ehlers-Danlos syndrome

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Contributor Information and Disclosures

Author

Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine
Jack Bragg, DO, FACOI is a member of the following medical societies: American College of Osteopathic Internists and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher (Kit) Bartalos, DO, Fellow, Department of Gastroenterology, University of Missouri at Columbia
Disclosure: Nothing to disclose.

Rodney A Perez, MD, Medical Director, The Endoscopy Center, Asheville Gastroenterology Associates; Consulting Staff, Department of Gastroenterology, Mission St Joseph's Hospital
Rodney A Perez, MD is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

John B Marshall, MD, Professor, Department of Internal Medicine, Division of Gastroenterology, University of Missouri School of Medicine
John B Marshall, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, American Urological Association, Central Society for Clinical Research, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Maurice A Cerulli, MD, FACG, Chief, Division of Gastroenterology and Hepatology, Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Gastroenterology, New York Methodist Hospital, Cornell University
Maurice A Cerulli, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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