Skip to main content

Advertisement

Log in

Esophageal Diverticula: Pathogenesis, Clinical Aspects, and Natural History

  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

It has been gradually accepted that esophageal diverticula result from esophageal motor disorders rather than from primary anatomic abnormalities. Twenty-seven patients with these diverticula were evaluated with respect to pathogenesis, clinical aspects, diagnostic tests, therapy, and natural history for a mean of 27 months of followup. Thirteen diverticula were midesophageal, 11 were situated in the distal third of the esophagus, and 3 were in both regions. Esophageal dysmotility was observed in 85% of patients. Specific esophageal motor disorders were more frequent in association with diverticula of the distal third than in midesophageal diverticula, suggesting that they result from a pulsion mechanism. Traction was the possible mechanism in 27% of midesophageal diverticula. Endoscopic esophagitis was seen in one patient and abnormal acid reflux in 25% of the cases, mainly in patients with distal diverticula. Distal diverticula presented with more severe symptoms than did midesophageal diverticula, and 27% of those required surgical treatment. Patients with midesophageal diverticula seem to have a better prognosis than those with more distal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. Evander A, Little AG, Ferguson MK, Skinner DB: Diverticula of the mid and lower esophagus: Pathogenesis and surgical management. World J Surg 10:820–828, 1986

    Article  PubMed  CAS  Google Scholar 

  2. Giuli R, Estenne B, Richard CA, Jacob L: Diverticules de l’oesophage. A propos de 221 cas. Ann Chir 26:435-443, 1974

    Google Scholar 

  3. D’Abreu AL: Diverticula of the oesophagus. Br J Radiol 22:423-426, 1949

    Article  PubMed  CAS  Google Scholar 

  4. Fulp SR: Esophageal Diverticula. In: Castell DO (ed.): The Esophagus. Boston: Little, Brown, 1992, pp 351–366

    Google Scholar 

  5. Lerner AM, Katz R: A new syndrome of left vocal cord paresis and esophageal diverticulum due to mediastinal fibrosis. Am J Roentgenol Radium Ther Nucl Med 125:193–197, 1975

    PubMed  CAS  Google Scholar 

  6. Nehra D, Lord RV, DeMeester TR, Theissen J, Peters JH, Crokes PF, Bremner CG: Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 3:346-354, 2002

    Article  Google Scholar 

  7. Webster BH: Spontaneous perforation of esophageal diverticulum: Report of a case with surgery. Dis Chest 31:345–348, 1957

    PubMed  CAS  Google Scholar 

  8. Sauvanet A, Gayet B, Lemée J, Fékété F: Les cancers sur diverticule de l`oesophage. Presse Méd 21:305–308, 1992

    PubMed  CAS  Google Scholar 

  9. Duda M, Sery Z, Vojacey K, Rocek V, Rehulka M: Etiopathogenesis and classification of esophageal diverticula. Int Surg 70:291–295, 1985

    PubMed  CAS  Google Scholar 

  10. Paulino F: Diverticula of digestive system. Hospital 68:763–771, 1965

    PubMed  CAS  Google Scholar 

  11. Malafaia O, Marchesini JB, Ribas Filho GV: Esophageal diverticulum. Rev Col Bras Cirur X:179–182, 1983

    Google Scholar 

  12. Fuentes P, Bordigoni L, Giudicelli R: Epiphrenic diverticula—What is the frequency of associated gastroesophageal reflux? In: Giuli R, McCallum RW, Skinner DB (eds.): Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, p 918

    Google Scholar 

  13. Pinotti HW, Cecconello I, Zilberstein B: Diverticulae of Esophagus. In: Pinotti HW (ed.):Tratado de Clínica Cirúrgica do Aparelho Digestivo. São Paulo, Brasil: Editora Atheneus, 1994, pp 292–299, vol I

    Google Scholar 

  14. Cross FS, Johnson GF, Gerein AN: Esophageal diverticulum associated to neuromuscular changes in the esophagus. Arch Surg 83:525-533, 1961

    PubMed  CAS  Google Scholar 

  15. Dodds WJ, Stef JJ, Hogan WJ, Hoke SEO, Stewart ET, Arndorfer RC: Radial distribution of esophageal diverticulum. Gastroenterology 69:584-590, 1975

    PubMed  CAS  Google Scholar 

  16. Habein HC Jr, Moerrsch HJ, Kirklin JW: Diverticula of the lower part of esophagus: a clinical study of one hundred and fourty nine non-surgical cases. Arch Intern Med 97:768-777, 1956

    Google Scholar 

  17. Ferreira-Santos R: Aperistalsis of the esophagus and colon (megaesophagus and megacolon) etiologically related to Chagas’disease. Am J Dig Dis 6:700-726, 1961

    Article  PubMed  CAS  Google Scholar 

  18. Costa MMB, Da Nova JLL, Carlos MT, Pereira AA: Videofluoroscopy—a new method. Radiol Bras 25:11-18, 1992

    Google Scholar 

  19. Savary M, Miller G: The esophagus. In: Handbook and atlas of endoscopy. City, Switzerland: Gassman AG, 1978, pp 135-139

  20. Gonlachanvit S, Fisher RS, Parkman HPE: Diagnostic modalities for achalasia. Gastroint Endosc Clin North Am 11:293-309, 2001

    CAS  Google Scholar 

  21. Lemme EMO, Moraes-Filho JPP, Domingues G, Firman CG, Pantoja JA: Manometric findings of esophageal motor disorders in 240 Brazilian patients with non-cardiac chest pain. Dis Esophagus 13:117-121, 2000

    Article  PubMed  CAS  Google Scholar 

  22. Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing of patients with non-cardiac chest pain or dysphagia. Ann Intern Med 106:593-597, 1987

    PubMed  CAS  Google Scholar 

  23. Sanderson DR, Ellis FH, Schlegel JF, Olsen AM: Syndrome of vigorous achalasia: clinical and physiologic observations. Dis Chest 53:508-517, 1967

    Article  Google Scholar 

  24. McCallum RW: Spasms localized to the lower part of the esophagus are a new entity. In: Giuli R, McCallum RW, Skinner D (eds.): Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 834–836

    Google Scholar 

  25. Lemme EMO, Almeida SM, Firman CMG, Pantoja JP, Nascimento FAP: Prolonged esophageal pH monitoring: evaluation of 170 tests. Arq Gastroenterol 34:71-77, 1997

    PubMed  CAS  Google Scholar 

  26. Johnson LF, DeMeester TR: Twenty four hour pH monitoring of the distal esophagus—a quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325-332, 1974

    PubMed  CAS  Google Scholar 

  27. Benacci JC, Deschamps C, Trastek VF, Allen MS: Epiphrenic diverticulum: results of surgical treatment. Ann Thor Surg 55:1109-1114, 1993

    Article  CAS  Google Scholar 

  28. Kaye MD: Oesophageal motor dysmotility in patients with diverticula of the mid-thoracic oesophagus. Thorax 29:666–672, 1974

    Article  PubMed  CAS  Google Scholar 

  29. Fasano NC, Levine MS, Rubesin SE, Redfern RO, Laufer I: Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia 18:9-15, 2003

    Article  PubMed  Google Scholar 

  30. Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO: Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 42:1859-1865, 1997

    Article  PubMed  CAS  Google Scholar 

  31. Spechler ST, Castell DO: Classification of oesophageal motility disorders. Gut 49:145-151, 2001

    Article  PubMed  CAS  Google Scholar 

  32. Hennessy TPJ: Epiphrenic diverticula—Significant symptoms are more often due to the coexisting motor disorder than to the diverticulum itself. In: Giuli R, McCallum RW, Skinner D (eds.): Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 908–909

    Google Scholar 

  33. Altorki NK, Skinner DB:What is the incidence of associated motility disorders? In: Giuli R, McCallum RW, Skinner DB (eds): Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, pp 913–914

    Google Scholar 

  34. Belsey RH: Mediothoracic diverticula—Can their congenital origin be proved? In: Giuli R, McCallum RW, Skinner DB (eds): Primary Motility Disorders of the Esophagus. Paris: John Libbey Eurotext, 1991, p 907

    Google Scholar 

  35. Vincre G, Mauri A, Brambilla G, Scuzzarella SI: Diverticoli dell’esophagus—implicazioni cliniche e tratamento chirurgigo da una disarmina di 89 casi. Minerva Chir 43:1279–1281, 1988

    PubMed  CAS  Google Scholar 

  36. Achem AS, Kolts BE, Wears R, Burton L, Richter JE: Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol 88:187-192, 1983

    Google Scholar 

  37. Silva LFD, Lemme EMO: Nutcracker esophagus : clinical evaluation of 97 patients. Arq Gastroenterol 37:217-224, 2000

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research used equipment funded by Fundação José Bonifácio, Federal University of Rio de Janeiro, Brasil. The authors thank the late Professor Abércio Arantes Pereira and Professor Elise Tonomura who performed and read the CT scans, the staff of the Endoscopy Unit, Division of Gastroenterology, who performed the upper GI endoscopies, and Ms. Rachel Calegário Gomes who did the statistical analysis. Thanks are also go to Dr. Felix R. Zyngier for his comments and review of this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eponina M. Oliveira Lemme.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nascimento, F.A.P.d., Lemme, E.M.O. & M.B.Costa, M. Esophageal Diverticula: Pathogenesis, Clinical Aspects, and Natural History. Dysphagia 21, 198–205 (2006). https://doi.org/10.1007/s00455-006-9028-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-006-9028-5

Key words

Navigation