What to Know About Esophageal Diverticulum

Medically Reviewed by Minesh Khatri, MD on February 20, 2024
3 min read

Esophageal diverticulum is a fairly rare condition. Treatment is usually only needed if you have other underlying conditions or it becomes severe. Here’s what you need to know.

A diverticulum is a pouch or sac that bulges out in some of your organs. When you have more than one diverticulum the plural is called diverticula. Diverticula can happen in your esophagus, which is the hollow tube that attaches your mouth to your stomach. 

This condition is sometimes called esophageal diverticulitis if there is inflammation or infection in the diverticula. Esophageal pouches don’t normally get infected, though, and the condition usually doesn’t need to be treated. 

There are a few different esophageal diverticulum types. Some are classified by the section of the esophagus they’re in, some by how they pouch out, and some by the layers of tissue. These include:

  • Zenker’s diverticulum. These are pockets in the throat at the top of the esophagus and behind the upper esophageal sphincter, a valve at the upper end (throat) or lower end (stomach) of the esophagus. These are also called pharyngeal diverticulum. 
  • Mid-esophageal diverticulum. As the name suggests, these happen in the middle section of the esophagus.
  • Epiphrenic diverticulum. These pockets happen at the bottom of the esophagus near the sphincter to your stomach.
  • Congenital diverticula. These types are present at birth.
  • Acquired diverticula. These show up later in life. 
  • Pulsion diverticula.  This type is described by how it’s formed. Pulsion means pushing or driving, so pulsion diverticula happen when the esophagus is pushed outward from inside.
  • Traction diverticula. In this type, pressure from the outside of the esophagus pulls the tissue out so that it bulges. 
  • True diverticula. True diverticula affect all the layers of the esophagus.
  • False diverticula. These pouches only affect the inner linings of the esophagus, called the mucosa and the submucosa. 

Esophageal pockets can happen for a few different reasons, though the condition is still not well understood. They can happen with some movement disorders in the esophagus, like achalasia, that causes trouble swallowing, muscle spasms, and regurgitation. Regurgitation happens when you bring swallowed food back up into your mouth. 

In Zenker’s diverticulum, problems with the upper sphincter causes pressure in the esophagus during swallowing. It often is caused by a problem coordinating between moving food and relaxing the upper sphincter, or muscle. 

Inflammation or infection in your chest cavity can cause mid-esophageal diverticulum. This irritation causes pressure on the esophagus, leading to pockets.

Epiphrenic diverticula at the bottom of the esophagus are caused by pressure that builds up as stomach contents are pushed against the lower sphincter. The pressure causes the tissue to bulge out. These often happen in motility disorders, too.

Other causes of esophageal diverticulum include:

  • Weakness in the esophagus wall
  • Inflammation and damage to the esophagus lining, called esophagitis
  • Sphincter disorders
  • Esophageal scleroderma, where the esophagus tissue tightens and makes it hard to swallow

Symptoms of esophageal diverticulum vary from nonexistent to mild to severe. They may worsen over time as the pouches stretch. You might have:

You might also have some specific Zenker’s diverticulum symptoms such as:

  • Regurgitation when you bend over
  • Regurgitation when you lie down
  • Inhaling food while you’re asleep
  • Lump in your neck

In most cases, esophageal diverticulum doesn’t require medical treatment. If you don’t have any symptoms or they’re mild, eating and lifestyle changes can help. You can:

  • Eat a bland diet.
  • Take small bites of your food.
  • Chew slowly and fully.
  • Drink water during and after meals.
  • Sit upright while eating.

If your diverticula are caused by an underlying condition like a motility disorder, treating that condition can help. For example, injecting Botox into your lower esophageal sphincter can help achalasia.

Sometimes the pockets in your esophagus can get too big or continual pressure can cause a tear in the lining. In these cases, you might need surgery.

Speech and language therapy can help you learn ways to swallow and food and drink to help lower your risk of breathing food into your lungs. It can also help if your voice is affected.