PHYSIOPATHOLOGY OF LOWER ESOPHAGEAL DIVERTICULUM AND ITS IMPLICATIONS FOR TREATMENT

  • 1 January 1980
    • journal article
    • research article
    • Vol. 151  (5) , 593-600
Abstract
Esophageal motor disturbances and pathogenesis of symptoms in patients with lower esophageal diverticulum are defined. Patients (65) were investigated by manometry in addition to roentgenography and endoscopy. Some fifty had manometric evidence of abnormal motility, most often diffuse spasm or achalasia. Of the 15 patients with normal esophageal motility, 13 had hiatal hernia and 5 of these had a high grade distal esophageal stricture. Pressures in the lower esophagus and lower esophageal sphincter in patients with lower esophageal diverticulum and motor disturbance were the same as for those in matched patients with motor disturbances but no diverticulum. Dysphagia, chest pain and regurgitation were common presenting symptoms. Of 46 patients with dysphagia, only 10 had mechanical obstruction to explain this symptom. Of 32 patients with chest pain, only 2 had ulceration in the diverticulum as a possible cause of pain. The development of lower esophageal diverticulum and its symptoms are apparently associated with a motor disturbance of the esophagus in the majority of patients and with an organic obstruction in the minority of patients. The diverticulum itself is usually not the sole cause of the esophageal symptoms, although diverticula can produce symptoms in the absence of other definable conditions. When surgical treatment is indicated, the diverticulum should be excised and the underlying motor or mechanical obstruction should be corrected to prevent serious postoperative complications and recurrence of the diverticulum and its symptoms.

This publication has 0 references indexed in Scilit: