Esophageal Diverticulum: A Guide to This Rare Condition

Medically Reviewed By Kelsey Trull, PA-C
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An esophageal diverticulum is a protrusion in the wall of the esophagus. The condition usually causes no symptoms. It also does not require treatment unless it is large or causing problems. Diverticular disease is a condition people associate with the intestines. However, the term refers to sacs or pouches that protrude from any tubular body structure. This includes the esophagus. 

This article explains esophageal diverticulum symptoms, causes, diagnosis, and treatments. 

What is a diverticulum in the esophagus?

Man eating and drinking water with his meal
Pedro Merino/Stocksy United

A diverticulum in the esophagus is a pouch-like protrusion in the wall of the esophagus. This tube carries food from the mouth to the stomach. The esophagus wall has a muscular layer that contracts to move food downward. A diverticulum sticks out through this layer of muscle.

An esophageal diverticulum is a fairly rare condition. Estimates indicate it affects less than 1% of the population. Anyone can develop a diverticulum in the esophagus. However, it typically occurs more in older adults and biological males than females.

What are the types of esophageal diverticulum?

There are a few ways to classify esophageal diverticulum. One of the main ways uses its location in the esophagus.

There are three segments of the esophagus — cervical, thoracic, and abdominal. The cervical section is just below the back of the throat. The thoracic segment is the midsection. The abdominal portion is the end of the esophagus near the stomach.

The three types of esophageal diverticula include:

  • pharyngeal diverticulum (Zenker or Zenker’s diverticulum), which is a pouch that forms in the upper or cervical portion of the esophagus
  • midesophageal diverticulum (Rokitansy diverticulum), which affects the thoracic esophagus
  • epiphrenic diverticulum, which develops in the lower portion or abdominal esophagus just above the diaphragm

What are the symptoms of esophageal diverticulum?

Most people with an esophageal diverticulum do not have symptoms. They may never know they have the condition unless they start having symptoms.

Symptoms may develop if the diverticulum becomes large. The typical symptom is difficulty swallowing, also known as dysphagia. However, dysphagia due to diverticulum is rare. Dysphagia has many other causes.

A Zenker diverticulum can collect food that people regurgitate. This is more likely when someone bends over or lies down. Retained food in a Zenker diverticulum can also cause bad breath and a cough.

Other possible symptoms of esophageal diverticulum include:

What causes esophageal diverticulum?

There are two basic ways esophageal diverticulum forms:

  • Pulsion: This means pushing. Pulsion diverticulum results from increased pressure inside the esophagus. This pushes the pouch outward when there is weakness in the wall. A lack of coordination between the muscles and sphincters of the esophagus can cause this kind of pressure.
  • Traction: This is a pulling from the outside of the esophagus to form the pouch. Inflammation and fibrosis in the chest pulling on the esophageal is the main cause.

Pharyngeal and epiphrenic diverticula form from pulsion. Midesophageal diverticula are usually due to traction but can also be related to pulsion.

Esophageal motility disorders can contribute to an esophageal diverticulum. Esophageal motility disorders are abnormal nerve and muscle contractions that can change or slow the motion of the esophagus. These include achalasia and esophageal spasms. Research indicates this is the case in more than 75% of epiphrenic diverticula cases.

How do doctors diagnose esophageal diverticulum?

To diagnose esophageal diverticulum, doctors will review the medical history and perform an exam. However, the main symptom, difficulty swallowing, can mean many things. Therefore, a barium swallow is necessary for a diagnosis of esophageal diverticulum.

Sometimes, doctors find an esophageal diverticulum during a swallow study for other problems. This can occur because most people with an esophageal diverticulum do not have symptoms.

How do you treat esophageal diverticulum?

Treatment for an esophageal diverticulum is not always necessary. Unless it grows very large or causes symptoms, doctors may recommend leaving it alone.

Doctors may recommend treatment for:

  • a large esophageal diverticulum 
  • bothersome symptoms
  • the presence of malignancy or cancer

Treatment is surgical and may include:

  • diverticulectomy, which involves removing the diverticulum
  • diverticulopexy, which involves repairing the diverticulum 
  • diverticular inversion, which involves eliminating the pouch by cutting the muscle that is causing traction and creating the pouch  

There are both minimally invasive endoscopic and traditional open surgery options. Endoscopy is the preferred method for most people. It carries less risk of nerve damage and infection than open surgery.

Midesophageal and epiphrenic diverticula typically do not cause symptoms or require treatment. 

Pharyngeal diverticula are more likely to cause problems and lead to surgery. However, not everyone is a surgical candidate. Advanced age or health problems may limit treatment options. In this case, doctors may recommend dietary changes to manage symptoms. This includes eating a bland diet and drinking after each bite to wash away food from the diverticulum.

Treating any accompanying esophageal motility problems can also be helpful.

Esophageal diverticulum types, locations, causes, and treatment

TypeWhere it formsHow it formsTreatment
pharyngeal diverticulum
(Zenker or Zenker’s diverticulum)

upper or cervical portion of the esophagus

most common esophageal diverticulum type

pulsion 

more likely to lead to surgery

dietary changes can help manage symptoms

midesophageal diverticulum
(Rokitansy diverticulum)
thoracic esophagus, mid-chest area

traction 

can also be related to pulsion 

typically does not cause symptoms or require treatment
epiphrenic diverticulumlower portion or abdominal esophagus, above the diaphragmpulsiontypically does not cause symptoms or require treatment

Summary

Esophageal diverticula are relatively rare. When they occur, most people are unaware they have the condition. Symptoms usually do not occur unless the pouch grows large. Symptoms are also more likely with diverticula in the upper portion of the esophagus.

Doctors most often treat these pharyngeal or Zenker diverticula with endoscopic surgery. When esophageal motility disorders occur, treating them may help with the diverticulum.

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Medical Reviewer: Kelsey Trull, PA-C
Last Review Date: 2022 Sep 16
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Chaudhry, S. R., et al. (2021). Anatomy, thorax, esophagus. https://www.ncbi.nlm.nih.gov/books/NBK482513/
  2. Lynch, K. L. (2022). Esophageal diverticula. https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/esophageal-diverticula
  3. Sato, H., et al. (2019). Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441918/
  4. Yam, J., et al. (2022). Esophageal diverticula. https://www.ncbi.nlm.nih.gov/books/NBK532858/