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Esophageal diverticula are called a disease of civilization, typical of inhabitants of developing countries, especially those over 40 years of age. Slight diverticula are usually nothing to worry about. The problem is larger diverticula which, if left untreated, can lead to, for example, serious inflammation. What are the causes and symptoms of esophageal diverticula? How is this condition treated? Which complications are the most dangerous?
Esophageal diverticulais a pouch-shaped bulge with a diameter of several millimeters to several centimeters, located in the wall of the esophagus. The formation of a diverticulum occurs as a result of a significant increase in esophageal pressure, which pushes the mucosa through the muscle layer. Esophageal diverticula can be single, most often found in the esophagus, or multiple.
Esophageal diverticula - causes and risk factors
There are congenital esophageal diverticula, which are the result of developmental disorders, and acquired esophageal diverticula, which result from the disease process (e.g. esophageal achalasia, mediastinal inflammatory disease, tuberculosis). In he althy people, esophageal diverticula are most often a consequence of an inadequate diet - rich in processed products and preservatives, and low in fiber. It's good to know that the incidence of diverticula increases with age.
Types and symptoms of esophageal diverticula
1. Pharyngophageal (Zenker) diverticulum
The diverticulum, which forms at the border of the lower pharynx and the esophagus, often causes throat tightness and the passage of food from the stomach into the esophagus without gagging. In addition, the patient may complain of belching and bad breath. With significant filling of the Zenker's diverticulum, you can feel it with your hand on the left side of the larynx.
2. Esophageal diverticula
The diverticulum, which is located in the middle of the esophagus, usually does not show any characteristic symptoms because it is too small.
3. Diverticula in the supra-diaphragmatic esophagus
The supra-diaphragmatic diverticulum usually becomes symptomatic when it becomes large. It can cause hiccups, swallowing disorders and regurgitation.
In 20-30 percent of cases, symptoms such asincreasing difficulty in swallowing solid and liquid foods, regurgitation of undigested food, abdominal pain in the lower and left quadrants, constipation or diarrhea (sometimes alternating), bloating and excessive gas production.
ImportantA dangerouscomplication of esophageal diverticulamay be acute diverticulitis. Then fever and abdominal pain appear. The inflammatory process within the diverticula can lead to abscess formation, bleeding from the diverticulum, and even a perforation (perforation) of the diverticulum, which may result in peritonitis. Then immediate medical intervention is necessary.
In rare cases, the diverticulum may developsquamous cell carcinoma(most often from Zenker's diverticulum), which is mainly found in patients over 55 years of age with a large diverticulum.
Esophageal diverticula - diagnosis
If esophageal diverticula are suspected, X-rays with contrast are ordered. Endoscopic examination of the esophagus with specimen collection to exclude a neoplastic lesion also plays an important role in the diagnostic process. This type of test is not performed in people with complications. In such a situation, computed tomography is recommended.
Esophageal diverticula - treatment
Asymptomatic esophageal diverticula do not require treatment. If inflammation is found, anti-inflammatory treatment is required.
In periods of exacerbation of symptoms, a low-residual diet and periodic (1-2 days) liquid diets are recommended.
Significant difficulty in swallowing and any complications (e.g. hemorrhages, perforation, obstruction symptoms) require surgery.