Esophageal Diverticula: Symptoms, Diagnosis, and Treatment Options

Suspected esophageal diverticulum and corresponding ostomy treatment?

Hello, doctor.
I would like to inquire about a long-standing esophageal issue that has worsened recently, prompting me to make an appointment.
Since childhood, I have had some difficulty swallowing pills, not only due to their bitterness but also because I have trouble swallowing their solid form through normal means.
However, as I have aged, I have sensed that the situation is more complicated.
Even when I chew them thoroughly and tighten my jaw to facilitate the opening of the esophagus (in the past, I would try placing the medication at the back of my tongue to swallow), the solid particles and capsules still have a chance of getting stuck in spaces that do not belong to the trachea or esophagus.
I can distinctly feel the shape of the medication mixed with saliva (I usually swallow dry and then drink water).
Regardless of how much water I try to wash it down with, it often does not budge at all; getting it to enter the esophagus seems almost entirely based on luck (sometimes it starts to dissolve quickly, and while I may not taste the bitterness, I am certain that having medication stuck there long-term will only cause greater problems).

At the same time, I experience spontaneous burping, chronic bad breath, a slight foreign body sensation when swallowing saliva, and the feeling of medication or food being stuck in an unclear space in my throat.
It was only yesterday that I learned about the existence of esophageal diverticulum (my family had previously joked that I was overthinking), and my symptoms almost perfectly match.
Could this situation be attributed to the aforementioned esophageal diverticulum? Or is this condition not exclusive to esophageal diverticulum and must be confirmed through a physician's examination? (A few days ago, I attempted to swallow medication and food that was stuck in my throat, consuming over two liters of water in the process, and now I feel a sensation of being constricted even when breathing.
I have already decided to make an appointment to determine the existence of any pouch-like spaces.) Additionally, if surgery is unavoidable, considering the side effects of postoperative healing and the duration of the surgery, I have only found information about a unique laser esophageal diverticulum surgery available in northern hospitals.
Is this the only solution?

Nian, 20~29 year old female. Ask Date: 2019/08/31

Dr. Zheng Jueyi reply Otolaryngology

Hello, esophageal diverticula are not within the specialty of otolaryngology.
It is recommended to seek medical examination or consultation with a gastroenterologist or thoracic surgeon.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2019/08/31

More Info

Esophageal diverticula are abnormal pouches that can form in the esophagus, often leading to a variety of symptoms and complications. Understanding the symptoms, diagnosis, and treatment options for this condition is crucial for effective management.

Symptoms of Esophageal Diverticula
The symptoms you describe, such as difficulty swallowing (dysphagia), a sensation of food or pills getting stuck in the throat, spontaneous belching, and chronic bad breath (halitosis), are indeed consistent with esophageal diverticula. Other common symptoms include:
- Regurgitation: This can occur when food or liquid comes back up from the esophagus.

- Coughing: Especially after eating or drinking, as food may enter the airway.

- Chest pain: This can be mistaken for heart-related issues.

- Weight loss: Due to difficulty eating or swallowing.

Diagnosis
Diagnosis of esophageal diverticula typically involves a combination of clinical evaluation and imaging studies. A physician may perform:
1. Barium Swallow Study: This X-ray test involves swallowing a barium solution, which helps visualize the esophagus and any diverticula on X-ray images.

2. Endoscopy: A flexible tube with a camera is inserted through the mouth to directly visualize the esophagus and assess for diverticula or other abnormalities.

3. Esophageal Manometry: This test measures the rhythmic muscle contractions in your esophagus when you swallow, helping to identify any motility issues.

Given your symptoms and history, it is essential to consult a gastroenterologist who can perform these diagnostic tests to confirm the presence of diverticula and rule out other conditions.

Treatment Options
Treatment for esophageal diverticula depends on the severity of symptoms and the presence of complications. Options include:
1. Observation: If the diverticula are small and not causing significant symptoms, a watchful waiting approach may be taken.

2. Dietary Modifications: Softening food, eating smaller meals, and avoiding tough or dry foods can help manage symptoms.

3. Medications: Proton pump inhibitors (PPIs) may be prescribed if there is associated gastroesophageal reflux disease (GERD).

4. Surgery: If symptoms are severe or complications arise (such as aspiration pneumonia or significant swallowing difficulties), surgical intervention may be necessary. The most common surgical procedure for diverticula is diverticulectomy, which involves removing the diverticulum. In some cases, minimally invasive techniques, such as laser surgery, may be available.

Considerations for Surgery
Surgical options, including the laser diverticulotomy you mentioned, can be effective but come with risks such as infection, bleeding, and complications related to anesthesia. The decision to proceed with surgery should be made in consultation with your healthcare provider, considering your overall health, the severity of your symptoms, and the potential benefits versus risks.

Conclusion
Your symptoms warrant a thorough evaluation by a gastroenterologist to confirm the diagnosis of esophageal diverticula and to discuss the most appropriate treatment options. It is essential to address these issues promptly, as untreated diverticula can lead to more serious complications. Make sure to communicate all your symptoms clearly during your appointment, as this will aid in accurate diagnosis and effective management.

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