Esophageal Diverticulum


An esophageal diverticulum is a pouch or sac that forms in the lining of the esophagus, the muscular tube that connects the mouth to the stomach.

Esophageal diverticula are rare, occurring in less than 1% of the U.S. population. The condition often produces no noticeable symptoms, which means most people with an esophageal diverticula may not know they have it.

Esophageal diverticula can be classified into three main types:

  • Pharyngeal diverticula (AKA Zenker diverticula), which is the most common type, and are usually located in the upper part of the esophagus near the back of the throat.
  • Mid-esophageal diverticula (AKA midthoracic diverticula), which are located in the middle portion of the esophagus
  • Epiphrenic diverticula, which are located in the lowest portion of the esophagus, near the stomach.
Why Hoag for Esophageal Diverticulum Evaluation and Treatment?

Hoag’s comprehensive, fully-integrated Foregut Program is the best in the business when it comes to treating serious or recurring conditions of the esophagus and stomach. Our program offers a patient-centered approach, drawing on the latest advancements in techniques and technology to help patients find answers other programs might miss. The result: better outcomes, and fuller recoveries.

Need treatment for esophageal diverticulum in Orange County? Hoag is here for you every step of the way.

Symptoms and Causes of Esophageal Diverticulum


In most cases, esophageal diverticula do not cause any symptoms, and do not require treatment. However, some people with esophageal diverticula may experience symptoms including:

  • Difficulty and/or pain when swallowing
  • Boyce’s Sign, which is a gurgling sound that occurs as air passes through the diverticulum.
  • Regurgitation of undigested food while lying down at night
  • Pulmonary aspiration, which is the recurring entry of food or liquids into the airways that can lead to choking
  • Neck pain
  • Having a hoarse voice
  • Pneumonia caused by food or liquid in the airways
  • Unexplained weight loss
  • Bad breath (AKA halitosis)
  • A recurring cough
  • A swelling or mass in the neck (rare)
  • Esophageal rupture
  • Squamous Cell Carcinoma, a type of cancer that develops in approximately .5% of those with esophageal diverticulum
Causes and Risk Factors

The exact cause of esophageal diverticula is not known, but it is believed it may be related to the pressure produced by the esophagus while moving food from the throat to the stomach.

There are, however, several known factors that may put you at greater risk of developing esophageal diverticulum. These include:

  • Having a motility disorder of the esophagus, including achalasia.
  • Your age, as esophageal diverticula are more common in people over the age of 50 and much more common in people over 70.
  • Having a history of esophagitis, which is an inflammation of the esophagus
Take Hoag’s Free, 5-Minute Online Assessment to Evaluate Your Risk of GERD


Diagnosis and Tests for Esophageal Diverticulum

If you are experiencing symptoms consistent with esophageal diverticula, your doctor may recommend certain tests to definitively diagnose the condition. These tests may include:

  • Barium swallow: This test involves drinking a liquid that contains barium, which makes the esophagus visible on an X-ray. This test can help identify the location and size of the diverticulum.
  • Esophageal manometry: This test measures the pressure and movement of the muscles in the esophagus and can help identify any problems with swallowing.
  • Endoscopy: During this test, a thin, flexible tube with a camera and a light at the end is inserted through the mouth and into the esophagus to examine the lining of the esophagus and look for signs of a diverticulum. Explore Hoag’s Orange County endoscopy centers located near you
Advanced Diagnosis of Conditions of the Esophagus and Stomach at Hoag

As Orange County’s recognized leader in the accurate diagnosis and treatment of conditions involving the stomach and esophagus, the Hoag Digestive Health Institute is here for those facing serious conditions involving these crucial digestive organs, including GERD, esophageal diverticulum and esophageal cancer.

At Hoag, advanced procedures used to diagnose or treat conditions involving the stomach and esophagus include:

Management and Treatment for Esophageal Diverticulum

In most cases, esophageal diverticula do not require treatment, especially if there are no symptoms. However, if you are experiencing symptoms that are bothersome to you, your doctor may recommend certain management strategies and treatment options. These may include:

  • Eating a bland diet
  • Taking smaller bites of food when you eat, chewing slowly and completely
  • Drinking plenty of water during meals and after eating
  • Improving your posture while eating
  • Surgery to remove the diverticulum in severe cases

Advanced Treatment Options for Issues involving the Stomach and Esophagus at Hoag

At Hoag, we’re committed to finding and using the latest and most advanced treatment options for conditions involving the esophagus and stomach. At Hoag, options for the treatment of these organs include:

  • Enterra Therapy, which is an implantable device to control chronic nausea and vomiting often associated with gastroparesis – a condition in which the stomach cannot empty itself of food normally
  • Radiofrequency Ablation (RFA), which is a treatment that uses high-frequency electrical currents to create a small area of heat that destroys the cancer cells.
  • LINX Reflux Management System, which is an implantable, FDA-approved device that treats GERD symptoms and stops reflux. Hoag is one of only three centers in California to offer this life-changing technology.
  • Nissen Fundoplication, which is a surgery to reinforce and strengthen the lower esophageal sphincter
  • Toupet Fundoplication: Anti-Reflux Surgery, which a type of anti-reflux surgery that is most often used in cases where the patient has difficulty swallowing in addition to traditional reflux symptoms.
  • Transoral Incisionless Fundoplication (TIF), which is a minimally invasive, non-surgical procedure that corrects a weakened esophageal sphincter, which causes chronic gastroesophageal reflux disease (GERD). The TIF procedure is performed entirely within the stomach, using an endoscope passed down the throat, and requires no incisions.

Prevention of Esophageal Diverticulum

The search for why some people develop esophageal diverticulum while others don’t is ongoing. As such, there is no definitive way to prevent yourself from developing an esophageal diverticula. However, there are several things you can do to potentially reduce your risk of developing the condition, including:

  • Eat a healthy diet with plenty of fruits, vegetables and whole grains
  • Chew your food slowly and fully
  • Drink plenty of water during meals and after eating
  • Maintain a healthy weight
  • Avoid smoking and excessive alcohol consumption
  • Seek treatment for GERD, acid reflux and other conditions that can increase the risk of developing a diverticulum.

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