Is something stuck in your throat when you swallow? It could be an esophageal diverticulum!

Do you feel like there's something stuck in your throat or a lump in your throat when you swallow? Sometimes, after a while, especially when you bend or twist, do you feel like the food you've eaten comes back up into your throat? The cause of this may be a small pouch that forms in your esophagus, the tube through which we swallow food. In medical terms, we call this an Esophageal Diverticulum . Don't be scared when you hear this name, let's talk about it simply.

Simply put, what is this Esophageal Diverticulum?

Think of your esophagus, the muscular tube that carries food from your mouth to your stomach, as a tire on a car. Sometimes, if there's a weak spot in a tire, the air pressure inside causes a small bubble to bulge out of that weak spot, right? That's how it is with this one.

If there is a weak spot in the mucous lining of our esophagus, the pressure created when we swallow food causes a small pouch, or hole, to form outside that weak spot. That's what we call an Esophageal Diverticulum . Some of the food and liquids you swallow can get trapped inside this pouch.

What are the main types of this condition?

Doctors divide these pouches (diverticula) into several types based on how they form and where they are located. Let's take a look at the main types.

First of all, there are two types of these: "true" and "false".

• True Diverticulum: In this case, the pouch is formed by bulging outwards from all layers of the esophageal wall, including the muscles.
• False Diverticulum: In this, only a few of the inner layers of the wall bulge outward.

Now let's see how these are classified according to their location in the esophagus.

Is this a very common situation?

No, this is actually a very rare condition . It affects approximately 1% of the population. It is most common in people over the age of 50, especially after the age of 70. It is also slightly more common in men than women.

Do you also have these symptoms?

Many people have this diverticulum but don't experience any symptoms. You may not even know you have it for the rest of your life. But if you do, it's most likely a Zenker diverticulum. See if you're experiencing any of these symptoms:

• It feels like a tickle in the throat and that's why you cough .
• Feeling like there is a lump in your throat when swallowing food.
• Feeling like food is stuck in the throat .
• Regurgitation is the return of food into the throat when you bend or tilt.
• Bad breath for no particular reason.
• Sometimes a wheezing sound comes from the chest.

Why does something like this happen? What are the reasons?

There are two main types of causes for these to occur. One is internal pressure (Pulsion), and the other is external traction (Traction).

1. Due to pressure (Pulsion Diverticula)

Most esophageal diverticula develop this way. This is when there is constant pressure on the same spot inside the esophagus. Most of the time, this pressure occurs when we swallow. This abnormal pressure can also be caused by other medical conditions that make it difficult to swallow.

Some such conditions are:

• Achalasia: Inability to relax the muscles in the lower part of the esophagus.
• Esophageal spasms: Irregular contractions of the muscles in the esophagus.
• Esophageal strictures: A narrowing or narrowing of the esophagus.
• Eosinophilic esophagitis: Inflammation of the esophagus due to an allergy.

2. Due to traction (Traction Diverticula)

This is when something outside the esophagus pushes the wall outward. This creates "true" diverticula, meaning the entire thickness of the wall is pushed inward. These often form in the middle of the esophagus. This is caused by tissue from inside the chest cavity swelling, sticking to the esophagus, and then pulling it outward.

Infections that can cause swelling of the chest tissue include:

• Tuberculosis
• Histoplasmosis (a fungal infection)

What complications can this cause?

Over time, this pouch (diverticulum) can gradually grow larger. This increases the risk of food getting stuck inside it. When food gets stuck like this, you may feel like a lump in your throat. Also, the stuck food can cause infection, pain, and swelling .

The stuck food can cause bad breath, a bad taste in the mouth, and in severe cases, it can even feel like a lump in the neck.

Another thing is that the stuck food can come back up into the throat when you change positions, for example when you bend over. This can cause coughing and shortness of breath. The most dangerous thing is that if this happens at night while you are sleeping , food particles can go into your lungs without you even realizing it. In medicine, we call this silent aspiration . This can cause an infection in the lungs, which is called Aspiration Pneumonia .

Is this cancer? Is there a risk?

This question may have come to you too. This condition is not actually cancer. However, very rarely , that is, in a very small number of people with this diverticulum, it has been found that cancer cells ( squamous cell carcinoma ) have grown inside this pouch. It is not yet clear whether chronic irritation caused by long-term food getting stuck in this pouch can be a cause of this. But remember, this risk is very small .

How do you recognize this condition?

Most of the time, this is discovered by chance. This pouch is only discovered when your esophagus is being examined for another condition. However, if you have symptoms, your doctor will order a test to examine your esophagus. There are two main methods for this. These are radiology and endoscopy.

Here are some types of tests you can do:

• Esophagram (Barium Swallow Test): This is like an X-ray. You are given a chalky liquid called barium to drink. When this is swallowed, the inside of the esophagus can be seen clearly. Then, as you swallow it, a video X-ray (fluoroscopy) is taken. This will show you if there is a sac.

• Upper Endoscopy (EGD Test): This involves inserting a small camera-equipped tube through your mouth to examine your esophagus and stomach. You will be given anesthesia to make sure you don't feel any discomfort during this procedure. The images from the camera can be viewed on a computer screen, allowing the doctor to see exactly where and how large the diverticulum is.

• Esophageal Manometry Test: This test may be done if you suspect that the diverticulum is causing difficulty swallowing. This test checks how strong your muscles are and how well they are working.

What are the treatments for this?

The good news is that most esophageal diverticula don't require any treatment . If you don't have any symptoms or complications, you can just let it go.

However, if your symptoms are interfering with your daily life or if complications occur, the sac may need to be removed or closed. There are several ways to do this. You may also need to treat the underlying condition that caused it.

Treatment methods

• Surgical Repair: A surgeon can cut out and remove the pouch completely (diverticulectomy). Or, they can sew it back into the wall of the esophagus (diverticulopexy). Sometimes, if the cause is muscle tightness, a procedure called a myotomy (cutting and loosening a muscle) may be done at the same time as this surgery.

• Endoscopic Diverticulotomy: This is a simpler procedure than surgery. An endoscope is inserted through the mouth and the septum is cut between the diverticulum and the wall of the esophagus. This is done using instruments such as a laser, electrocautery, or a stapler. These instruments cut and seal the wound at the same time.

Your doctor will discuss with you the treatment method that is best suited to your condition.

How long does it take to recover after treatment?

After the treatment, you will need to stay in the hospital for about a day. Then you will need to go home and rest for a few weeks. In the first few days, your throat may be sore and swollen. This can make it a little difficult to swallow.

Your doctor will give you painkillers. They will also give you instructions on how to start with liquid foods, gradually transitioning to soft foods, and then to regular foods. Following these instructions is very important for a speedy recovery.

So if you have these symptoms, don't be afraid to see a doctor and get advice. He or she will run the necessary tests for you, clearly explain whether you have this condition, and if so, what to do next.

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