Esophageal Diverticula 

  • Author: Jack Bragg, DO; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Background

A diverticulum is a sac or pouch arising from a tubular organ, such as the esophagus. This article focuses on diverticula of the esophagus. As is common practice, Zenker diverticulum, a type of diverticulum that arises from the posterior hypopharynx, is also discussed in this article.

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Pathophysiology

Besides anatomical location, several other ways to classify diverticula of the esophagus and hypopharynx exist. Congenital diverticula are diverticula that are present at birth, while acquired diverticula develop later in life. Diverticula of the esophageal body can sometimes be difficult to classify as congenital or acquired.[1]

Diverticula also may be classified on the basis of histopathology. True diverticula contain all layers of the intestinal tract wall. False diverticula, also known as pseudodiverticula, occur when herniation of mucosa and submucosa through a defect in the muscular wall occurs (eg, Zenker diverticulum). A special type of pseudodiverticula, believed to represent dilated excretory ducts of esophageal submucosal glands, is observed in the condition esophageal intramural pseudodiverticulosis.

Finally, acquired diverticula of the esophagus and hypopharynx also may be classified according to their pathogenesis as pulsion diverticula or traction diverticula. Pulsion diverticula form as a result of high intraluminal pressures against weaknesses in the GI tract wall. Zenker diverticulum occurs due to increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter. An epiphrenic diverticulum occurs from increased pressure during esophageal propulsive contractions against a closed lower esophageal sphincter.[2] In contrast, traction diverticula occur as a consequence of pulling forces on the outside of the esophagus from an adjacent inflammatory process (eg, involvement of inflamed mediastinal lymph nodes in tuberculosis or histoplasmosis).

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Epidemiology

Age

Most esophageal diverticula occur in middle-aged adults and elderly people. Presentation in infants and children is rarely seen.

Zenker diverticula typically present in people older than 50 years and especially present during the seventh and eighth decades of life.

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Contributor Information and Disclosures
Author

Jack Bragg, DO  Associate Professor, Department of Clinical Medicine, University of Missouri School of Medicine

Jack Bragg, DO 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 Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF  Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Barium esophagram, anteroposterior view, demonstrating a bilobed Zenker diverticulum.
Zenker diverticulum, lateral view.
Esophagram demonstrating a dilated tortuous esophagus and a large midesophageal diverticulum.
Barium esophagram demonstrating an epiphrenic diverticulum.
Multiple, small, flask-shaped outpouchings characteristic of esophageal intramural pseudodiverticulosis.
Esophageal intramural pseudodiverticulosis involving the entire length of the esophagus.
 
 
 
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