(See also Overview of Esophageal and Swallowing Disorders.)
There are several types of esophageal diverticula, each of different origin:
Zenker (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation.
Midesophageal (traction) diverticula are caused by traction resulting from mediastinal inflammatory lesions or, secondarily, by esophageal motility disorders.
A Zenker diverticulum fills with food that might be regurgitated when the patient bends or lies down. Aspiration pneumonitis may result if regurgitation is nocturnal. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass.
Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be.
Specific treatment is usually not required, although resection is occasionally necessary for large or symptomatic diverticula. Diverticula associated with motility disorders require treatment of the primary disorder. For example, case reports suggest doing a cricopharyngeal myotomy when resecting a Zenker diverticulum. There are also emerging endoscopic treatment options for diverticulectomy.