Esophageal Diverticula

Updated: Dec 24, 2020
  • Author: Jack Bragg, DO; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Overview

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.

Most esophageal diverticula occur in middle-aged adults and elderly people​; they are rarely seen in infants and children. Zenker diverticula typically present in people older than 50 years and are especially present during the seventh and eighth decades of life, particularly in males. [1]

Complications of esophageal diverticula may include recurrent aspiration pneumonia, which has been associated with large symptomatic esophageal diverticula and Zenker diverticula, and, rarely, carcinoma that develops within a diverticulum.

For patient education resources, see Digestive Disorders Center as well as Diverticulosis and Diverticulitis.

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Pathophysiology

Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic). 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. [2]

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. [3] 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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Etiology

Most diverticula are caused by an underlying motility disorder of the esophagus. Structural lesions, including a noncompliant cricopharyngeus muscle (ie, Zenker diverticulum), incomplete or uncoordinated relaxation of the lower esophageal sphincter, or strictures, may play a role as well. An underlying inflammatory process within the mediastinum has been associated with mid esophageal diverticula.

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