Disorders of the gastrointestinal tract today in medicine are diagnosed very often in people of both sexes and different age groups. One of the pathologies that is observed in 2% of people around the world is the diverticulum of the esophagus, which is characterized by a saccular protrusion of its wall, communicating with the lumen. Often this disease causes suppuration of the esophagus, the occurrence of bleeding and narrowing of the lumen, the appearance of fistulas and the formation of cancerous tumors. Pathology is usually accompanied by other diseases of the digestive tract, for example, a stomach ulcer or duodenal ulcer.
Description of the problem
The esophagus diverticulum is a pathological process of deformation of the walls of the esophagus, protrusion of its layers towards the mediastinum in the form of a sac. In gastroenterology, such a protrusion is diagnosed in 40% of cases, most often in men after 50 years. The disease is usually accompanied by cholecystitis, a stomach ulcer or other diseases.
The esophageal diverticulum ICD code has K22.5 and Q39.6, which includes congenital and acquired diverticula. With untimely treatment of the disease, complications develop, in particular necrosis and inflammation of the sac, its rupture.
The formation of diverticulums can develop in the cervical, thoracic or abdominal esophagus, but most often the pathology is localized in the chest. There is also a Zenker diverticulum located in the pharyngeal-esophageal region of the organ.
Stages of the disease
The disease goes through three stages of development:
- The first stage in which the protrusion of the epithelium of the esophagus through weak points occurs.
- The second stage is characterized by the formation of a sac that is localized between the spine and esophagus.
- The third stage is caused by an increase in the size of the sac, which can sink into the mediastinum and become a continuation of the esophagus. In severe cases, the bag may contain up to one and a half liters of liquid.
Esophageal diverticulums: classification
In medicine, it is customary to distinguish the following types of pathology:
- A true diverticulum is characterized by a protrusion of the walls of an organ in the form of a sac, which consists of a muscle, mucous, and outer layer.
- False diverticulum is caused by protrusion of the organ wall as a result of pathology in the muscle layer, so the sac in this case consists only of the mucous membrane and the outer membrane.
By origin, the disease is congenital, is formed in the prenatal period as a result of abnormal development of the fetus, and acquired. The latter type, in turn, is divided into traction, which is formed due to regular stretching of the walls of the organ; pulsion, when the neoplasm develops under the influence of external factors; combined. Diverticulums can also be single (90% of cases) and multiple (10% of cases).
Causes of the disease
The diverticulum of the esophagus may have different causes. Congenital pathology is formed due to abnormal development of the esophageal wall in a certain area, in which its muscle layer is weak.
Acquired pathology occurs as a result of inflammatory processes of the digestive tract and mediastinum. In this case, provoking factors include:
- Gastroesophageal reflux disease (GERD) and esophagospasm.
- Esophagitis and tuberculosis.
- Inflammation of the lymph nodes.
- The presence of infections in the esophagus.
- Injuries and strictures of the esophagus.
- The fusion of the walls of the organ.
A pulsed diverticulum is formed with an increase in pressure in the organ, due to the protrusion of its wall. Usually this phenomenon is observed with stenosis of the esophagus or with a disorder of its peristalsis. Traction diverticulum appears due to the fusion of the wall of the esophagus with the internal organ, which pulls it towards itself, forming a protrusion. This phenomenon can be observed with the development of the inflammatory process.
Symptoms and signs of the disease
Usually, the diverticulum of the esophagus manifests symptoms in different ways, depending on the location of the pathological site. The most striking signs are the Zenker diverticulum. In this case, there is difficulty in passing food through the esophagus. It accumulates in a bag, a person periodically spits up undigested food, he develops a putrid smell from his mouth, sore throat, sensation of a lump, dry cough. This pathology is accompanied by nausea, a change in the timbre of the voice, redness of the face, suffocation, dizziness, as well as loss of consciousness. Such phenomena usually pass after vomiting.
Small esophageal diverticulums usually do not show symptoms. With pathology of the lower esophagus, shortness of breath, bronchospasm, tachycardia, pain in the region of the heart are observed. Diverticuli are often accompanied by the formation of fistulas, phlegmon of the neck, sepsis, bronchitis, pneumonia, or lung abscess.
Complications and consequences
If untreated, this pathology can lead to suppuration and perforation of diverticula, resulting in bleeding. Fistulas and oncological neoplasms in the esophagus are also possible. Often a complication is aspiration pneumonia, pleurisy, and lung abscess, as well as angina pectoris and arrhythmia, mediastinitis.
The most common complication of the disease is diverticulitis - inflammation in neoplasms as a result of their defeat by pathogenic bacteria, as well as accumulations of food debris that begin to rot. Therefore, with the manifestation of signs of such a pathology as the diverticulum of the esophagus, clinical recommendations will be aimed at strict adherence to all prescriptions during therapy.
Diagnosis of the disease
When conducting a diagnosis, the doctor first studies the medical history, conducts an examination and questioning of the patient. Then the doctor prescribes a radiography in order to determine the location of the pathological area, the width of its neck, as well as the presence of other formations, for example, polyps or cancerous tumors.
The doctor also prescribes the following diagnostic methods:
- CT scan of the chest.
- Esophagoscopy in order to study the diverticulum cavity, deformation of the epithelium, the presence of bleeding, tumors. Using this technique, a biopsy is often performed. Biological material after the procedure is sent for histological examination.
- Esophageal manometry for the study of esophageal motility.
- ECG, echocardiography, Holter monitoring in the presence of coronal symptoms.
- Laboratory blood tests.
The doctor differentiates the diverticulum of the esophagus with diseases such as GERD, esophageal strictures, cancer, cystic neoplasm in the mediastinum, angina pectoris, coronary heart disease, as well as esophageal hernia, esophagospasm. For this, other diagnostic methods can be used. After a comprehensive examination, a treatment regimen is developed in each case.
Pathology therapy
Treatment of the diverticulum of the esophagus is not carried out only if it does not bother the person. At the same time, the patient is under observation and periodically undergoes examination in order to control the development of pathology. It is possible to prescribe medications that help eliminate the problem. Often, doctors prescribe antibacterial drugs, antacids, secretolytics and prokinetics.
Be sure the doctor prescribes a sparing diet with a diverticulum of the esophagus. In this case, spicy dishes, alcohol are excluded from the diet. All products must be steamed or in the oven. It is also recommended to consume a large amount of pure water per day, and after eating, rinse the esophagus with an antiseptic solution. People with this disease must follow certain rules to improve the emptying of the diverticulum.
People who are at risk often undergo electrocoagulation and laser therapy. Using special equipment, it is possible to restore the space between the bags, to normalize the lumen of the esophagus. Such treatment is carried out in a hospital.
Surgery
In the presence of a high risk of complications, as well as when a large diverticulum of the esophagus, surgery is mandatory. Most often, doctors cut off the neoplasm and suture the esophagus. Sometimes you need to perform plastic walls of the organ with material taken from the pleura or diaphragm. All operations are performed under local anesthesia. After surgery, patients are under the supervision of a doctor for a long time. In case of poor health after the operation, an increase in body temperature, they speak of the development of complications that need to be addressed. After surgery, the patient should be under the supervision of a doctor, undergo follow-up examinations.
The operation can also be carried out in the case when the patient himself expressed a desire to get rid of this problem.
Usually, surgery is performed through the cervical region or chest, depending on the location of the sac. The type of surgical intervention is determined by the attending physician depending on the symptoms of the disease, the localization of education and the general condition of the patient.
After the operation, the development of complications such as mediastinitis, inconsistency of the surgical suture, nerve paresis, and wound infection are possible. Therefore, shortly before and after the operation, antibacterial drugs are prescribed.
Alternative medicine
Treatment of an esophageal diverticulum with folk remedies is acceptable only as an additional method of therapy and after consultation with a specialist. Typically, alternative methods are used to eliminate the symptoms of the disease. In this case, it is recommended to cleanse the intestines using a special diet, which includes cereals from germinated millet and apples. This diet must be followed for 20 days. Also during this period, you can use bran, drink liquid jelly based on oats. To eliminate the inflammatory process, an infusion of rose hips, dill seeds or chamomile broth is well suited. It must be remembered that traditional medicine cannot replace the main treatment.
Forecast
Usually the diverticulum of the esophagus has a favorable prognosis; after surgery, it is possible to completely eliminate the pathology and all unpleasant symptoms. In the presence of complications, the prognosis will be less "good", therefore, even the asymptomatic course of the disease requires diagnostic measures. In the most severe and advanced cases, a fatal outcome is possible. It is not recommended to independently treat the pathology, as unpleasant consequences may develop, which will be difficult to eliminate.
Prevention
For the purpose of prevention, doctors recommend timely treatment of diseases of the digestive tract, eat food slowly, chewing it thoroughly. It is also necessary to exclude strongly hot or cold dishes from the diet, eat food while sitting, exclude snacks on the go, and also avoid injuring the esophagus and follow the instructions of a nutritionist.
Esophageal diverticulum is quite common in gastroenterology today. Such a pathology may be congenital or acquired. Often, refusal of treatment and non-observance of a healthy lifestyle leads to the development of complications that can cause significant harm to human health. Today, the disease can be cured in many ways, but it is important to prevent the development of complications, so it is recommended to do this in a timely manner. If you find unpleasant symptoms of the disease, you must immediately contact a medical institution, self-medication is not recommended.