INTRODUCTION:

The Esophagus is the main tube that connects the mouth and the stomach. It is a very important part of the digestive system. Different substances pass through it daily and expose it to different risks. A number of conditions can develop in the esophagus such as; Esophageal cancer, Gastroesophageal reflux disease, Diverticulum of the esophagus, and more.  An esophageal diverticulum is a very common condition developed in the esophagus and it should be discussed extensively since it affects the digestive system.

WHAT IS DIVERTICULUM OF THE ESOPHAGUS?

The esophageal diverticulum is a condition of the esophagus that results in difficulty when swallowing food. The constant swallowing performed by the esophagus can weaken the muscles and tissues that line the tract. Asa result, it can cause a part of the Esophagus to swell and form a sac-like shape. When food is then taken in and transported down the track, some of the food particles get trapped in the sacs. Hence, the difficulty in swallowing.
In simple terms, the diverticulum of the esophagus is a swollen pouch found on the lining of the esophagus.

TYPES OF ESOPHAGEAL DIVERTICULUM:

Most times, diverticulum of the esophagus are classified according to their location in the esophagus.
Considering the location, there are three major types of esophageal diverticulum: Zenker’s diverticulum, Midthoracic diverticulum, and Epiphrenic diverticulum.

Zenker’s Diverticulum:  It is located at the top of the esophagus and is the most common type of Esophageal diverticulum. It’s just above the upper esophageal sphincter. It doesn’t affect the entire wall of the esophagus. It is also known as a hypopharyngeal diverticulum.

Midthoracic Diverticulum:  Just like the name implies, this type of diverticulum occurs in the middle of the esophagus, i.e mid-chest region.

Epiphrenic Diverticulum: Epiphrenic diverticulum is located in the lower region of the esophagus just above the diaphragm. It’s the rarest type of diverticulum of the trio.

WHAT CAN CAUSE ESOPHAGEAL DIVERTICULUM?

Physicians do not know the exact cause of the Diverticulum of the esophagus. Most studies tend to reach an inconclusive end. Although extensive research has shown that some people are affected by the condition from birth while some develop it later in life.

Also, there are certain conditions that have been found to be associated with people who develop this diverticulum. One of the major conditions is the increased pressure in the esophagus. The pressure increase causes a formation of the diverticulum pouch when the muscles and tissue linings are stressed.

There is a range of things that could initiate a pressure increase in the esophagus, and they include:

Swallowing Big Chunks Of Food: The muscles of the esophagus are responsible for pushing down the food you consume. When you swallow food in big portions, the muscles will require higher pressure to pass it down, so it’s always advisable to swallow in bits.

Malfunctioning Of The Upper Or Lower Esophageal Sphincter: When the sphincters are damaged, taking food in or out of the esophagus becomes harder than normal. Hence, leading to increased pressure in the tract.
Inflammation of the esophagus: Any form of inflammation in or around the esophagus will disrupt the movement of food and it’ll eventually create more pressure in the esophagus.

WHAT ARE THE SYMPTOMS?

Often, people who are diagnosed with a diverticulum of the esophagus have shown to be asymptomatic (they don’t show symptoms). But we’ve also seen that the symptoms grow over time with the growth of the diverticulum.
So, it’s very possible that you won’t show any form of symptom at an early stage. However, you will start developing the symptoms as the size of the pouch increases.

Common Symptoms That Could Be Observed Are:

Dysphagia: Is a condition in which you begin to have difficulty swallowing food. When esophageal diverticulum is present, you’ll begin to feel a sensation like the food swallowed is being stuck in your throat.

Regurgitation: You’re said to be regurgitating when you begin to taste the food you’ve swallowed in your mouth after a while. Esophageal diverticulum sometimes causes regurgitation of food and saliva.

Severe Cough: Another common symptom for diverticulum of the esophagus is coughing. Typically occurs when it is chronic. The diverticulum irritates your throat and causes you to start coughing.

Pain In The Throat: You might begin to feel a sharp pain in the throat especially when trying to swallow food because of the diverticulum. Sometimes, the pouch grows to a point where the tissue linings begin to tear.

Bad Breath: You might also begin to experience bad breath because of the irritation in the esophagus. The torn tissues might carry an offensive odor. It will escape when air passes through the esophagus.

Weight Loss: Some people begin to experience significant weight loss that they can’t explain.

Aspiration Pneumonia: It is a condition that starts the moment food goes into the lungs. Diverticulum of the Esophagus can cause food swallowed to be moved back into the lungs especially the Zenker’s diverticulum.

Voice Changes: For you to be vocal, you need to push a certain amount of air through the esophagus. When diverticulum blocks the channel, producing enough air to be vocal becomes difficult so you begin to notice changes in your voice.

Neck pain: Also, the presence of esophageal diverticulum could cause one to start expressing sharp pain in the neck especially when you bend or lay down.

HOW CAN IT BE DIAGNOSED?

There are quite a number of ways or methods that could be adopted to diagnose the diverticulum of the esophagus in the hospital. Some of the common ones include:

Barium Swallow: It is a process that is also known as esophageal. You’ll be required to swallow certain liquids that contain Barium. Barium has a white precipitate that will allow the linings of your esophagus to be seen clearly during an X-ray scan. In so doing, they can trace how the food you consume moves in the tract. And if there’s any form of a swollen pouch, it would be easily spotted.

Gastrointestinal Endoscopy: In this test, a thin, plastic tube would be inserted down your throat. The tube would have light and a camera (endoscope). It would analyze the insides of your esophagus in order to detect any form of diverticulum that might be present.

Esophageal Manometry: This diagnosis examines the regular muscle contractions in your throat when you swallow. It also deals with the coordination and power exerted by the muscles of your esophagus.
24-hours pH Test: It involves the monitoring of the pH present in the esophagus over a period of 24 hours. From the test, they’ll be able to detect if there are any acidic contents from the stomach in the esophagus.

HOW CAN IT BE TREATED?

Treatment for diverticulum of the esophagus is mainly divided into two, depending on the size of the diverticulum itself. We have Non-surgical treatment and surgical treatment.

Non-Surgical Treatment: The nonsurgical treatment is often adopted for a mild esophageal diverticulum condition. Some of the treatments under this category are simple medications or lifestyle changes. Examples are:
1. Use of antacids to suppress symptoms.
2. Chewing food properly and avoiding swallowing big chunks of food.
3. Taking a lot of water before and after food to aid proper digestion, etc.

Surgical Treatment: Surgical treatment is often recommended when the condition is already severe and the size of the diverticulum has increased significantly. So, there will be a need to remove the sac and treat the tissues. There are different options available for the surgery.
1. Endoscopic diverticulectomy.
2. Cricopharyngeal myotomy
3. Diverticulopexy
4. Cricopharyngeal myotomy and more.
Your doctor will give you a breakdown of the procedures and which are best suited for you.

WHAT ARE THE RISK FACTORS?

There are a number of factors that can put one at the risk of developing esophageal diverticulum. A few of those factors include:

Age: Diverticulum of the esophagus can affect anybody across all ages. However, older adults especially those above 60 years are at a higher risk. The esophagus tissues tend to grow weak with increasing age.

Digestive Disorders: When there is a presence of other digestive disorders in the body like Gastroesophageal reflux disease, or general issues regarding swallowing of food like the achalasia condition. There is a high tendency of one developing esophageal diverticulum.

POSSIBLE COMPLICATIONS:

Without proper treatment or medication, esophageal diverticulum can eventually lead to different complications over time. A few popular ones are:
Lung Diseases: Diverticulum of the esophagus cause aspiration pneumonia as cited earlier. When it’s left unattended, it could become more severe and damage the lungs.

Squamous Cell Carcinoma: It is a form of cancer. It’s mostly caused by the uncontrolled growth of unwanted cells. If the diverticulum keeps growing, it could result in a squamous cell carcinoma.

CONCLUSION

While esophageal diverticulum might not be a life-threatening condition. Rare complications and symptoms shouldn’t be ignored and left untreated. Eating healthy can also go a long way in reducing the risk of developing the condition.

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