Complications
The following complications can occur as a result of diverticular disease of the esophagus:
- The trapped food can serve as a breeding ground for germs (bacteria). This can lead to an inflammation of the mucous membrane of the oesophagus (esophagitis). The inflammatory processes can in turn cause bleeding of the esophageal mucosa.
If a chronic inflammation leads to changes in the esophageal tissue, tubular infection ducts, so-called fistulas, can develop, which can create a connection to neighboring structures, especially to other hollow organs.
- The regurgitation of food residues can cause inhalation of these food residues (aspiration), especially at night. This can lead to repeated (recurrent) severe pneumonia (aspiration pneumonia) and pus ulcers in the lungs (pulmonary abscess).
- In very rare cases, overstretching of the diverticulum can lead to a tear (rupture) of the diverticular wall. This allows the passage of chyme into the chest cavity. This can cause a life-threatening inflammation of the mediastinum (mediastinitis).
- Patients with esophageal diverticulum also have an increased risk of developing a malignant esophageal tumor (esophageal carcinoma). Chronic irritation of the esophageal mucosa can trigger tissue remodeling processes, which in the worst case can lead to tumor development.
Diagnosis
X-ray – pap smear: During this examination the oesophagus is X-rayed while the patient swallows an X-ray contrast medium. The contrast medium is applied to the wall of the esophagus, whereupon it becomes accessible for evaluation. A characteristic feature of diverticular disease is the appearance of a contrast-filled round to bag-shaped esophageal bulge.
This is used because there is a particularly high risk of the contrast agent being aspirated (inhaled) into the lungs. If a non-water-soluble contrast medium were to enter the lungs, this would result in a foreign body reaction (reaction of the body to the contrast medium) and inflammation of the lung tissue, which is difficult to treat. Dynamic videofluoroscopy (radiological examination of swallowing): This examination method is significantly less radiotoxic and more informative than the classic X-ray swallow.
With a digital camera the esophagus is filmed and recorded during the act of swallowing. Diverticular sacculation and especially movement disorders of the esophagus during the act of swallowing can be well diagnosed. A further advantage is that in the assessment of esophageal movement disorders during repeat examinations, comparisons with previous images are possible and therapy progress can be documented.
Oesophagomanometry (measurement of oesophageal pressure): In this procedure, a thin tube (catheter) is first inserted through the nose into the stomach and then slowly withdrawn towards the mouth, whereby the patient must swallow some water regularly. When the catheter is pulled back, the internal esophageal pressure is permanently measured at the end of the catheter. A computer graphic shows the pressure conditions along the course of the esophagus.
Dysfunctions of the oesophagus can be diagnosed in this way. With this examination, functional disorders of the esophagus can be detected, as they can occur in the area of the lower esophageal sphincter muscle in the context of epiphrenal diverticula formation. Since parabronchial traction diverticula do not have an internal pressure increase of the esophageal wall as the cause of their formation, the examination of this type of diverticula is not meaningful Endoscopy (esophageal gastroscopy): “endoscopy” (endoscopy) of the esophagus is not a standardized procedure for diagnosing a diverticulum.
It is used when uncertainties remain from previous examinations (confirmation of diagnosis, exclusion of tumor), complications are to be assessed (inflammation) or a tissue sample (biopsy) is required. In a gastroscopy, a flexible tube camera (endoscope) is “swallowed” by the patient during light anesthesia, which then transmits images of the inside of the esophagus and stomach to a monitor.The most common reason for performing an endoscopy is to rule out an esophageal tumor. In the case of diverticular disease, the endoscopy must be performed with special care because the diverticular wall is not very stable and can easily be punctured with the endoscope.
