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 occurs in 2% of people worldwide is the diverticulum of the esophagus, which is characterized by a sac-like protrusion of its wall that communicates with the lumen. Often this disease causes suppuration of the esophagus, bleeding and narrowing of the lumen, the appearance of fistulas and the formation of oncological tumors. Pathology is usually accompanied by other diseases of the digestive tract, for example, a stomach or duodenal ulcer.
Problem description
Esophageal 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, stomach ulcers or other diseases.
Esophageal diverticulum ICD code is 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 diverticula can develop in the cervical, thoracic or abdominal esophagus, but most often the pathology is localized in the chest. There is also a Zenker's diverticulum, located in the pharyngoesophageal 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.
- The second stage is characterized by the formation of a pouch that is localized between the spine and the esophagus.
- The third stage is caused by an increase in the size of the sac, which can descend into the mediastinum and become a continuation of the esophagus. In severe cases, the pouch can contain up to one and a half liters of liquid.
Esophageal diverticula: classification
In medicine, it is customary to distinguish between the following types of pathology:
- A true diverticulum is characterized by a protrusion of the walls of the organ in the form of a sac, which consists of a muscular, 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 shell.
Pothe origin of the disease is congenital, formed in the prenatal period as a result of abnormal development of the fetus, and acquired. The latter type, in turn, is subdivided into traction, which is formed due to the regular stretching of the walls of the organ; pulsion, when the neoplasm develops under the influence of external factors; combined. Also, diverticula can be single (90% of cases) and multiple (10% of cases).
Causes of disease development
Esophageal diverticulum can have different causes. Congenital pathology is formed due to the 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 in the gastrointestinal tract and mediastinum. The provoking factors in this case include:
- Gastroesophageal reflux disease (GERD) and esophagus spasm.
- Esophagitis and tuberculosis.
- Inflammation of the lymph nodes.
- Presence of infections in the esophagus.
- Injuries and strictures of the esophagus.
- Fusion of the walls of the organ.
Pulsion diverticulum is formed when the pressure in the organ increases 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 esophageal wall with the internal organ, which pulls it towards itself, forming a protrusion. This phenomenon can be observed during the development of inflammatoryprocess.
Symptoms and signs of disease
Usually, a diverticulum of the esophagus shows symptoms in different ways, depending on the location of the pathological area. The most striking signs are shown by Zenker's diverticulum. In this case, there is a difficulty in the passage of food through the esophagus. It accumulates in a bag, a person periodically spits up undigested food, he has a putrid smell from his mouth, a sore throat, a feeling of a lump, a dry cough. This pathology is accompanied by nausea, a change in the timbre of the voice, reddening of the face, suffocation, dizziness, and loss of consciousness. Such phenomena usually disappear after vomiting.
Small esophageal diverticula usually do not show symptoms. In the pathology of the lower esophagus, shortness of breath, bronchospasm, tachycardia, and pain in the region of the heart are observed. Often, diverticula are accompanied by fistula formation, neck phlegmon, sepsis, bronchitis, pneumonia, or lung abscess.
Complications and consequences
If left untreated, this pathology can lead to suppuration and perforation of diverticula, resulting in bleeding. It is also possible the appearance of fistulas and oncological neoplasms in the esophagus. Often, aspiration pneumonia, pleurisy and lung abscess, as well as angina pectoris and arrhythmia, mediastinitis act as a complication.
The most common complication of the disease is diverticulitis - inflammation in neoplasms as a result of their defeat by pathogenic bacteria, as well as the accumulation of food debris,that are starting to rot. Therefore, if there are signs of such a pathology as a diverticulum of the esophagus, clinical recommendations will be aimed at strict adherence to all prescriptions during therapy.
Diagnosis of disease
When conducting a diagnosis, the doctor first examines the history of the disease, examines and interviews the patient. Then the doctor prescribes an x-ray to determine the location of the pathological area, the width of its neck, as well as the presence of other formations, such as polyps or cancer.
The doctor also prescribes the following diagnostic methods:
- Chest CT.
- Esophagoscopy to study the cavity of the diverticulum, deformation of the epithelium, the presence of bleeding, tumors. When using this technique, a biopsy is often performed. Biological material after the procedure is sent for histological examination.
- Esophageal manometry to study esophageal motility.
- ECG, ECHOCG, Holter monitoring in case of coronary symptoms.
- Laboratory blood tests.
The doctor differentiates the diverticulum of the esophagus with diseases such as GERD, esophageal stricture, cancer, cystic neoplasm in the mediastinum, angina pectoris, coronary artery disease, as well as hernia of the esophagus, esophagospasm. Other diagnostic methods can also be used for this. After a comprehensive examination, a treatment regimen is developed in each case.
Pathology Therapy
Treatmentesophageal diverticulum is not performed 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. Doctors often prescribe antibiotics, antacids, secretolytics, and prokinetics.
Be sure the doctor prescribes a sparing diet for diverticulum of the esophagus. In this case, spicy dishes and alcohol are excluded from the diet. All foods 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 need to follow certain rules to improve the emptying of the diverticulum.
People who are at risk often undergo electrocoagulation and laser therapy. With the help of special equipment, it is possible to restore the space between the sacs, to normalize the lumen of the esophagus. Such treatment is carried out in a hospital.
Surgical treatment
When there is 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 it is required to perform plastic surgery of the walls of the organ with material taken from the pleura or diaphragm. All operations are performed under local anesthesia. After surgery, patients are under medical supervision for a long time. ATin the case of poor he alth after surgery, an increase in body temperature, they indicate the development of complications that need to be eliminated. After surgery, the patient must be under the supervision of a doctor, undergo control examinations.
The operation can also be performed when the patient himself expressed a desire to get rid of this problem.
Usually, the operation is performed through the cervical region or the chest, depending on the location of the pouch. The type of surgical intervention is determined by the attending physician, depending on the symptoms of the disease, the localization of the formation and the general condition of the patient.
After the operation, complications such as mediastinitis, failure of the surgical suture, nerve paresis, infection of the wound may develop. Therefore, shortly before and after the operation, antibiotics are prescribed.
Alternative medicine
Esophageal diverticulum treatment with folk remedies is acceptable only as an additional method of therapy and after consultation with a specialist. Usually folk methods are used to eliminate the symptoms of the disease. In this case, it is recommended to cleanse the intestines with the help of a special diet, which includes cereals from germinated millet and apples. This diet should be followed for 20 days. Also during this period, you can eat bran, drink liquid jelly based on oats. To eliminate the inflammatory process, an infusion of wild rose, dill seeds or a decoction of chamomile is well suited. It must be remembered that the peoplemedicine cannot replace basic treatment.
Forecast
Usually, esophageal diverticulum 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 an asymptomatic course of the disease requires diagnostic measures. In the most severe and advanced cases, death is possible. It is not recommended to treat the pathology on your own, as unpleasant consequences may develop that 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 very hot or cold dishes from the diet, eat food while sitting, exclude snacks on the go, and also avoid injury to the esophagus and follow the dietitian's prescriptions.
Esophageal diverticulum is quite common today in gastroenterology. This pathology can be congenital or acquired. Often, refusal of treatment and non-compliance with a he althy lifestyle leads to the development of complications that can cause significant harm to human he alth. 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 symptoms of the disease are detected, it is necessary to immediatelygo to a medical institution, self-medication is not recommended.
