Diverticula, pockets in the lining of your gastrointestinal tract, are more common in your colon than in your esophagus. When an esophageal diverticulum occurs, it’s often related to another condition, such as a swallowing disorder. It might never bother you, but some diverticula can cause complications.
An esophageal diverticulum is an outpouching or pocket that develops on the inside of your esophagus. Your esophagus is the muscular swallowing tube that connects your mouth to your stomach. Your esophagus has a mucous lining, similar to the rest of your gastrointestinal (GI) tract. Esophageal diverticula (plural) occur in weak spots in your esophageal lining. They protrude outward, forming little caverns.
Esophageal diverticula (plural of diverticulum) are either “true” or “false”. A true diverticulum protrudes through all the layers of your esophageal wall, including the muscle. A false diverticulum only protrudes through some of the layers of the wall (the mucosa and submucosa). Providers also identify esophageal diverticula by their location in your esophagus. Diverticula in different regions tend to have different types of causes.
Esophageal diverticula are rare. They occur in approximately 1% of the population. They mostly occur in people older than 50, and especially after 70. They’re more common in men and people assigned male at birth (AMAB).
Esophageal diverticula often cause no symptoms. You might not ever know that you have one. Zenker diverticula are the type most likely to cause symptoms. If they do, you might notice:
There are two types of causes — pulsion and traction. Most esophageal diverticula are pulsion diverticula. Pulsion means pushing: Something is repeatedly pushing against the wall of your esophagus in one place. This usually happens when you’re swallowing food. Esophageal disorders that cause difficulty swallowing can create abnormal pressure inside your esophagus when you swallow.
Some of these include:
Traction diverticula occur when something applies traction to your esophagus wall and pulls against it from the outside. This creates true diverticula, indentations through the full thickness of the esophageal wall. Traction diverticula typically occur in your midesophageal or thoracic region, when swelling in your chest causes tissues to stick to your esophagus and then pull back.
Swelling in this region (mediastinitis) is often caused by an infection, such as:
Pulsion and traction diverticula are both acquired diverticula, which means they develop during your lifetime. Rarely, some esophageal diverticula may be present at birth. In other cases, a congenital weakness in your esophageal tissues in one region may make it easier to acquire an esophageal diverticulum there. But usually, you won’t develop one unless you have another disorder first.
Complications can happen as a diverticulum gradually enlarges over time, which increases the risk of food getting stuck in it. You might feel this as a lump in your throat when you swallow, or it might become infected and sore. Retained food may cause bad breath or a bad taste in your mouth. An infection may cause bleeding or swelling. In severe cases, it may produce a palpable lump in your neck.
Food may also get stuck temporarily and then come out later when you change positions (regurgitation). This can cause coughing, choking or irritation. If it happens at night when you’re asleep, it’s possible to accidentally inhale the piece of food (silent aspiration). This could lead to an infection in your lungs (aspiration pneumonia). This mostly happens with Zenker diverticula.
Esophageal cancer (squamous cell carcinoma) has been found in .05% of esophageal diverticula. It’s not clear if this is just an association or if the chronic irritation related to a diverticulum could be a cause.
Medical exams that look inside your esophagus will reveal an esophageal diverticulum. Since many esophageal diverticula don’t cause symptoms, they’re often discovered accidentally while looking for something else. If you do have symptoms in your esophagus, a healthcare provider will examine it with either radiology or endoscopy. Radiology takes pictures from the outside, while endoscopy goes inside.
Possible tests include:
Most esophageal diverticula don’t need treatment. If they don’t cause any symptoms or complications, you can leave them alone. But if a diverticulum does cause symptoms or complications, you can have a procedure to close it or remove it. Physicians have a few different ways of doing this. You may also need treatment for the original disorder that caused your esophageal diverticulum.
A physician can fix an esophageal diverticulum by surgery or by endoscopy. Different approaches may be better for different types of diverticula. Your physician will also consider your overall health when considering their approach. For example, endoscopy may be a better option if you want or need a minimally invasive approach. They’ll discuss the risks and benefits of each option with you.
A surgeon may repair your diverticulum either by cutting it out completely (diverticulectomy) or by suspending and stitching it to the esophageal wall (diverticulopexy). Surgical repair may also include a myotomy. Myotomy means cutting into one of your esophageal muscles to relieve excess tension. This may be necessary to address the swallowing disorder involved in your esophageal diverticulum.
An alternative approach to surgery is to pass a flexible endoscope through your mouth into your esophagus and operate through the endoscope. This approach is also called a Dohlman procedure. The endoscopist divides the septum (partition) between the diverticulum and the rest of the esophagus wall. They use a laser, electrocautery or stapling device, all of which can both cut and seal the wound.
You may need to stay in the hospital for a day, and then take it easy for a few weeks at home. Your throat may be sore and swollen for a few weeks, which can cause difficulty swallowing. You’ll have instructions on pain relief, though you may not need it. Your physician will advise you on how and when to progress from a liquid diet to a soft diet and finally, to resume your normal diet.
Most people with an esophageal diverticulum will never be bothered by it. But if you are, there are several ways to repair it. The success rate for esophageal repair is over 90%. There’s a 10% risk of complications from the procedure, such as bleeding, infection or injury to your esophagus. Your healthcare team will discuss with you the risks and benefits of different procedures on a case-by-case basis.
A note from Cleveland Clinic
You may develop an esophageal diverticulum, a pouch in your esophageal wall, if you have a condition that causes difficulty swallowing. Abnormal pressure when you swallow can cause your esophagus lining to create a pouch in a weak spot. It might never bother you. But if you start to notice new symptoms in your esophagus, see your healthcare provider. They can help diagnose and treat your diverticulum.
Last reviewed by a Cleveland Clinic medical professional on 09/29/2023.
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