Esophageal diverticula: pathogenesis, clinical aspects, and natural history.
It has been gradually accepted that esophageal diverticula result from esophageal motor disorders rather than from primary anatomic abnormalities. Twenty-seven patients with these diverticula were evaluated with respect to pathogenesis, clinical aspects, diagnostic tests, therapy, and natural history for a mean of 27 months of followup. Thirteen diverticula were midesophageal, 11 were situated in the distal third of the esophagus, and 3 were in both regions. Esophageal dysmotility was observed in 85% of patients. Specific esophageal motor disorders were more frequent in association with diverticula of the distal third than in midesophageal diverticula, suggesting that they result from a pulsion mechanism. Traction was the possible mechanism in 27% of midesophageal diverticula. Endoscopic esophagitis was seen in one patient and abnormal acid reflux in 25% of the cases, mainly in patients with distal diverticula. Distal diverticula presented with more severe symptoms than did midesophageal diverticula, and 27% of those required surgical treatment. Patients with midesophageal diverticula seem to have a better prognosis than those with more distal disease.
do Nascimento
Fernando Antonio Pinto
FA
Division of Gastroenterology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro Medical School, Rio de Janeiro, Brazil. LEMME@DOMAIN.COM.BR
Lemme
Eponina M Oliveira
EM
Costa
Milton M B
MM
D000328:Adult; D000368:Aged; D001464:Barium; D003679:Deglutition / Q000502:physiology; D004936:Diverticulum, Esophageal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000737:chemistry / Q000473:pathology*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009068:Movement; D014057:Tomography, X-Ray Computed; D014743:Videotape Recording
D001464:Barium