Do you sometimes feel like something is stuck in your throat when you swallow food? Or do you just have a bad smell coming from your mouth? These could be symptoms of a condition called an esophageal diverticulum, which we're going to talk about today. Don't worry, it's not that common. But it's good to know a little about it. Let's talk about it simply, in a way that you can understand.
What is this small pouch in the esophagus (Esophageal Diverticulum)?
Okay, first let's see what this (Esophageal Diverticulum) is. You know, we have a tube that takes food from our mouth to our stomach, we call it the esophagus . It's like a water pipe, but it's made of muscle. On the inside of this food pipe, sometimes it protrudes from weak spots in the wall, and it forms something like a little pouch, or a little pocket. That's why we call it this. Think of it like a tire on a car that gets old and bulges out a little bit in one place. That's what this is like.
There are two types of these small bags.
- 'True' pouch: This means that all layers of the wall of the oesophagus , including the muscular layer, are protruding.
- 'False' pouch: This is when only some layers of the wall, such as the mucosa and the layer underneath (submucosa), protrude. It's like only a few threads of a cloth are pulled out.
Doctors identify these cysts based on where they are located in the esophagus. The causes of cysts in different locations can vary.
What are the types of esophageal diverticulum?
Let's see what are the main types that can be seen.
Zenker's diverticulum
This is the most common type . It forms at the top of the esophagus, where the throat meets the mouth. Most often, these are 'false' pouches. The main reason is that when food is difficult to swallow , when the throat muscles do not work properly, the pressure inside the esophagus increases and pushes it out through a weak spot. Imagine a water pipe that is blocked at one point, and when the water comes in quickly, the pipe swells before the blocked spot.
Killian-Jamieson Diverticulum
This is a little less common. It occurs in the cervical esophagus, the part of our neck that runs parallel to the spine. It is often seen as a single, small 'false' pouch. It is thought to be caused by a congenital weakness in the tissues in that area.
Midesophageal Diverticulum
These are 'true' pouches. They form in the part of the esophagus that runs through the middle of our chest. They are also called thoracic diverticula , because they form in the chest cavity. They are sometimes called traction diverticula . The reason for this is that they form when an external force pulls on the wall of the esophagus. For example, lymph nodes in the chest can swell and stick to the esophagus, and then when the swelling goes down, the wall of the esophagus can pull.
Epiphrenic Diverticulum
This occurs at the end of the esophagus, just before the food enters the stomach (distal esophagus). These are often 'false' pouches. Here too, the cause is pressure. For example, if the lower part of the esophagus is blocked, the pouch can form due to the pressure that is created when food tries to pass through it into the stomach.
How common is this condition?
Esophageal diverticula are actually very rare . They are thought to affect only about 1% of the population. They are most common in people over the age of 50 , especially after the age of 70. They are also slightly more common in men than women.
What are the symptoms of an esophageal diverticulum?
Most of the time, these diverticula don't cause any symptoms . You may not even know you have one. However, a type called Zenker's diverticulum is more likely to cause symptoms. If you have these symptoms, you may experience:
- It feels like a cough with a tickle in the throat.
- A feeling like something is stuck in the throat when swallowing food.
- A feeling as if food is stuck in the throat.
- Food comes back up into the throat (regurgitation) when you bend forward or lie down.
- Bad breath for no reason.
- Wheezing is a whistling sound when breathing for no reason.
Some people have none of these symptoms and are only discovered by chance during a test done for another reason.
What causes esophageal diverticulum?
There are two main types of causes. One is pulsion causes, and the other is traction causes.
Pulsion pouches: Most esophageal pouches fall into this category. 'Pulsion' means "pushes." This means that there is a continuous internal pressure in the esophagus. This often happens when we swallow food. Some medical conditions in the esophagus that make it difficult to swallow food can cause this abnormal pressure. For example:
- (Achalasia) (lack of relaxation of the muscles of the lower esophagus)
- Esophageal spasms
- Esophageal strictures
- Eosinophilic esophagitis
Traction pouches: These are formed when something pulls on the wall of the esophagus from the outside and pulls it. This is what causes 'true' pouches, which are the entire thickness of the esophagus wall being pulled inwards. These are most often formed in the middle of the chest. An infection in the chest cavity (mediastinitis) can cause swelling, which can stick to the esophagus, and then pull the esophagus as the swelling goes down. Examples of such infections include:
- Tuberculosis
- Histoplasmosis , a fungal infection
Both of these causes are new growths that develop during our lifetime. Rarely, some anal sacs can be present at birth. Or, a congenital weakness in the tissues of the anal canal may make it easier for a sac to develop later. But most of the time, this sac does not develop unless another medical condition occurs first.
What are the possible complications of this esophageal diverticulum?
As this pouch gets bigger over time, food becomes more likely to get stuck inside . This can feel like a lump in your throat, or it can become infected and painful . The stuck food can cause bad breath and a bad taste in your mouth. If it gets infected, it can bleed and swell. In severe cases, it can feel like a lump that can be felt on the outside of your neck.
Another thing is that food can stay stuck for a while and then come back up into the throat when you change positions (for example, when you bend over). This can cause coughing, shortness of breath, and a sore throat. If this happens at night while you are sleeping, the food particles can go into the lungs without you realizing it (silent aspiration) . If this happens, it can cause an infection in the lungs (aspiration pneumonia) . This is most common in people with Zenker's diverticulum.
Is this cancer? Could it be cancer?
A very small percentage (about 0.05%) of people with esophageal diverticulum have been found to develop squamous cell carcinoma of the esophagus. However, it is not yet clear whether this is just a coincidence or whether chronic irritation from the diverticulum causes the cancer. However, this risk is very low .
How do you find out if you have an esophageal diverticulum?
A medical test that looks inside the esophagus can detect this sac. Most often, they are not symptomatic, so they are discovered incidentally during an exam for another reason. If you have symptoms related to your esophagus, your doctor will perform a test called either radiology or endoscopy. While radiology takes pictures from the outside, endoscopy uses a camera to look inside.
What kind of tests will be done?
Here are some possible tests:
- Esophagram / Barium Swallow Test:
This is a type of X-ray. A video (fluoroscopy) of your esophagus is taken while you swallow. In this, you are given a chalky liquid called barium to drink. It coats the inside of your esophagus. Then, an X-ray is taken while you swallow it. This allows you to clearly see the shape of your esophagus, the way food passes, and any pouches that may be present.
- Upper Endoscopy / EGD Test:
In this, a long tube with a small camera called an endoscope is inserted through the mouth and passed through the esophagus to the stomach. You will be sedated during this time, so you will not feel any discomfort. The images from the camera can be viewed on a computer screen. If there is a pouch, it can be seen directly.
- Esophageal Manometry Test:
Since swallowing difficulties are a major cause of pharyngeal pouches, your medical team may also suggest this test. This measures how hard the muscles in your throat contract when you swallow. These measurements are taken using sensors on a tube that is placed through your nose and into your throat.
What are the treatments for esophageal diverticulum?
Most scrotal sacs do not require treatment . If they are not causing any symptoms or complications, they can be left alone. However, if the sac is causing symptoms or complications, it may need to be closed or removed. Doctors have a variety of ways to do this. You may also need to treat the underlying condition that caused your scrotal sac.
How is an esophageal diverticulum treated?
A doctor can do this either through surgery or through an endoscopy. Different methods may be best for different types of pouches. Your doctor will decide which method is best for you based on your overall health. For example, if you want a minimally invasive procedure, an endoscopy may be a good option. Your doctor will talk to you about the risks and benefits of each method.
Surgical Repair
A surgeon can either completely cut out the pouch (diverticulectomy) or pull it up and sew it back to the wall of your esophagus (diverticulopexy) . The surgery may also involve a procedure called a myotomy . A myotomy is a procedure that cuts a muscle in your esophagus to reduce the tightness. This may be necessary to help with the difficulty swallowing that caused your pouch to form.
Endoscopic Diverticulotomy
An alternative to surgery is to insert an endoscope through the mouth into the esophagus and perform the surgery through it. This is also called the Dohlman procedure . This involves cutting the septum between the esophagus and the rest of the esophagus. This can be done using a laser, electrocautery, or a stapler. These devices can both cut and seal the wound.
How long does it take to recover after this surgery?
You will need to stay in the hospital for about a day. Then you will need to rest at home for a few weeks. Your throat may be sore and swollen for a few weeks. This can make it difficult to swallow food. Pain relief may be advised, but may not be necessary. Your doctor will advise you on how and when to start with liquid foods, gradually moving on to soft foods, and then to regular foods.
What is your final word on this situation?
Most people have an esophageal diverticulum and it doesn't cause any problems . But if it does, there are several ways to fix it. The success rate of these surgeries is over 90% . However, there is a 10% risk of complications such as bleeding, infection, or damage to the esophagus. Your medical team will discuss the risks and benefits of different treatment options with you individually.
If you have a condition that makes it difficult for you to swallow, you may develop a pouch like this in the wall of your esophagus. This pouch can form in a weak spot in your esophagus due to the abnormal pressure that occurs when you swallow. It may never bother you. But if you develop any new symptoms related to your esophagus, see a doctor. That way, they can determine exactly whether it's a pouch or something else and give you the necessary treatment.
Important things to remember (Take-Home Message)
- An esophageal diverticulum is a small pocket that forms in the wall of the esophagus.
- These are very rare and often do not show symptoms.
- If symptoms do occur, they may include difficulty swallowing, food getting stuck in the throat, and bad breath.
- Most of the time, these do not require treatment .
- However, if symptoms are severe or complications occur, surgery or endoscopic procedures can be successfully treated.
- It is important to seek medical advice if you have difficulty swallowing or new symptoms. Don't worry, doctors are there to help you.
I hope this information is useful to you. Stay healthy!
` Esophagus, esophageal, diverticulum, difficulty swallowing, sore throat, reflux, endoscopy
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න