Esophageal Pouches Health Article

Definition

Esophageal pouches, also known as esophageal diverticula, are pocket-like structures formed when the interior space of the esophagus, the tube that connects the mouth to the stomach, protrudes into the walls that surround it.

Description

The esophagus is a muscular tube that propels food into the stomach. A defect in the wall of the esophagus may allow the lining to herniate, creating a space where food can be caught. Pouches can appear anywhere between the throat and the stomach. They occur primarily in men and usually later in life.

Different names for the condition apply to different locations along the esophagus:

• Zenker's diverticula are pharyngeal pouches, or ones that occur in the upper neck area at the top of the esophagus.
• Traction diverticula are a type of mid-esophageal pouch.
• Epiphrenic diverticula occur at the bottom of the esophagus near where it enters the stomach.

Causes and symptoms

To propel food into the stomach (or out of it during vomiting) the esophagus generates internal pressure just like the bowel. Under certain circumstances, that pressure can herniate the esophageal lining through a weakness in the wall, creating a pouch (a balloon squeezed in the hand will herniate through the fingers in the same way). Pouches are more common in people who have motility disorders of the esophagus, swallowing that is not well coordinated and may be spastic. A traction diverticulum can develop from a scar that pulls the esophagus out of shape. Food and saliva can collect in all of these pouches.

Pouches in the neck usually cause bad breath (halitosis) and the regurgitation of swallowed food and saliva. Some patients with Zenker's diverticula can push on their neck and make old food appear in their mouths. Pouches near the stomach may cause swallowing problems, conditions known as achalasia or dysphagia. Mid-esophageal pouches usually cause no symptoms.

In the most serious cases, a person may be unable to swallow because the esophagus is obstructed, or the esphagus may rupture, spilling its contents into the chest or neck.