Divertulae of the esophagus - Causes, symptoms and treatment. MF.

Not everyone has a clear idea of ​​what esophageal diverticulum is. The more frightening the term may be for an apparently perfectly healthy person who is undergoing a routine examination, for example, and who does not have complaints from the digestive organs. What is it, what are the symptoms and in what cases is the treatment of the diverticulum required?

Diverticulum is an anomalous protrusion of the wall of the hollow organ, represented by all three( mucous, muscular and serous) or only one( mucous) membranes. If such saccular formation is located in the esophagus wall, then they speak of an esophageal diverticulum. In the first case, the diverticulum of the esophagus is considered true, and in the second - false, or pseudo diverticulum, when protrusion of the mucosa through the hole between the weak muscles of the esophagus is observed.

By itself, diverticulism is difficult to name a disease, since not always its presence is manifested by unpleasant symptoms. About the disease as such it is a case in cases of multiple formations in the wall of the esophagus, as well as with inflammatory phenomena in the cavity of the diverticulum, called

diverticulitis .Nevertheless, a patient with a confirmed esophageal diverticulum should be more careful about his health, conduct a survey and identify a background disease of the digestive tract, which caused weakness of the esophageal wall, and also be constantly observed by the doctor.

Most often, esophageal diverticulum occurs in men over 45 years of age who are susceptible to diseases of the gastrointestinal tract. In addition, this feature of the structure of the esophagus can be congenital and not cause discomfort throughout the life of a person.

In most cases, diverticulum is a single, but in about 10% of all cases multiple diverticula of the esophagus are noted. The protrusion can form in any part of the esophagus - in the cervical part( pharyngeal-esophageal, or Zenker's diverticulum), in the thoracic( mid-esophageal and supra-diaphragmatic diverticula) or in the ventral part( subdiaphragmatic diverticulum).More often there are protrusions in the thoracic esophagus.

Reasons for the formation of esophageal diverticula.

The causes of congenital diverticulum arising during fetal development are the harmful factors affecting the fetus - poor nutrition and harmful habits of the expectant mother, stresses, early and late toxicosis of pregnancy, adverse environmental conditions.

As a rule, the diverticulum acquired during the life of a diverticulum is caused by diseases of the gastrointestinal tract:

- esophagitis - an inflammatory disease of the esophagus, especially long-lasting,
- gastro-oesophageal reflux - throwing of gastric contents into the esophagus with mucous membrane damageesophagus with acidic gastric juice,
- gastric ulcer,
- cardiac achalasia and cardiospasm - abnormal narrowing of the esophageal-gastric sphincter with increased pressure in the lumenischevoda,
- gastric and esophageal injury,
- inflammatory and neoplastic diseases involving mediastinal organs in a process outside the esophageal wall - tuberculosis of intrathoracic lymph nodes, mediastinitis, adhesions in the mediastinum, etc.

symptoms..

The clinical manifestations of diverticula are different and are determined by the location and size of the protrusion. So, for example, a small diverticulum located in the thoracic esophagus may not manifest itself throughout the life of a person unless it undergoes an inflammatory process in it - diverticulitis.

The protrusion, localized in the abdominal part of the esophagus and in the zone of its passage into the stomach, can manifest itself by symptoms from the cardiovascular system due to the innervation characteristics of this area. These symptoms include tachycardia, dyspnea, pain in the heart, changes in the ECG.

Diverticula of the pharyngeal-esophageal region, or the Center diverticulum, have the most pronounced clinical symptoms. The main symptoms are:

- bad breath,
- dysphagia syndrome, or eating disorders, mostly hard,
- regurgitation syndrome, or frequent regurgitation of food eaten on the eve, especially at night in a horizontal position,
- sensation of a lump in the throat, even inbreaks between meals,
- feeling of sagging, sore throats, frequent coughing and choking,
- frequent bronchitis, laryngitis due to inhalation( aspiration) of food pieces from the diverticula and in connection with dysphagia,
- hoarseness,
- toshnote, increased salivation.

If you experience one or more of the symptoms described above, you should consult your doctor for a checkup.

Diagnostics.

After specifying the patient's complaints and examination, in which there may be a noticeably round formation in the neck area in the event of having a Zenker diverticulum, the doctor prescribes additional diagnostic methods, which include the following:

- radiopaque examination of the esophagus and stomach using contrasting barium suspension -the sign is the flow of contrast into the cavity of the diverticulum, on the roentgenogram is indicated by an arrow:

- esophagoscopy is mandatory for all patients with suspected pathologicale esophageal wall changes, allows visualization of the esophageal mucosa and localization of the diverticulum, and if necessary, in the presence of pathology, the extraction of pieces of esophagus tissues with further histological examination( biopsy),
- esophagomanometry - pressure measurement in the esophagus lumen - is indicated for persons with gastroesophagealreflux disease and cardiac achalasia,
- MRI or CT of the esophagus allow to give a clearer assessment of the nature and localization of the pathological process in the esophagus, RGANI mediastinal lymph nodes and chest cavity,
- cardiology consultation, ECG, ECG monitoring and blood pressure are held for the purpose of differential diagnosis of heart disease and blood vessels.
Only a physician should decide on the appointment of certain methods of examination.

Treatment of esophageal diverticula.

Diverticulum treatment is performed using conservative or surgical methods. It is impossible to completely get rid of the diverticulum in a conservative way, but to prevent the appearance of new ones against the background of the underlying disease of the gastrointestinal tract and improve the quality of life is quite feasible.

Conservative methods include:

- diet and diet,
- before eating one or two teaspoons of vegetable oil( sunflower or olive),
- a method that uses straining after each meal - at this time, increases intra-abdominaland intrathoracic pressure that facilitates the expulsion of food residues from the cavity of the diverticulum into the esophagus,
- rinsing of the throat after eating with warm water, washing down with a large amount of water, sometimes with the addition of weak antiseptic solutions(potassium permanganate, furatsilin), as well as the adoption of a certain posture in which the patient feels relief from symptoms associated with food intake,
- drug therapy for the underlying disease, for example, the appointment of proton pump inhibitors( omeprazole), H-2 receptor blockers( famotidine, ranitidine), drugs that reduce the acidity of gastric juice( antacids - renni, almagel) with gastroesophageal reflux disease, in addition to this antibiotics( amoxicillin, metronidazole) with peptic ulcer, etc.

XSurgical treatment of is strictly indicated in the development of complications, as well as in the presence of large diverticula that cause the appearance of severe clinical symptoms. The operation consists in excising the walls of the diverticulum followed by plasty of the esophagus with a diaphragmatic flap, or in directing the diverticulum into the lumen of the esophagus and then closing the esophagus wall. Determine the indications and contraindications to the operation can only the doctor after carrying out all the necessary diagnostic methods.

Lifestyle with esophageal diverticulum.

Compliance with recommendations for a healthy lifestyle in many ways improves the quality of life and prevents the development of complications. These recommendations include the following:

- complete rejection of bad habits,
- observance of work and rest regime with sufficient sleep at night,
- sleep with raised head,
- adherence to the diet with frequent fractional meals in small portions in warm form( exclude cold and hot food),
- cooking in steam, stewed or baked form,
- exclusion of harmful food - fast food products, fried, fatty, salty foods, canned food, spices, chocolate, coffee,
- restriction of sweet and flour products, fresh dairyode(fat milk, cream),
- adding to the diet of healthy foods - cereals, fresh and baked fruit, stewed vegetables, sour-milk products, vegetable oils, etc.

Complications of esophageal diverticula.

Compliance with basic treatment recommendations is rare. Nevertheless, the patient should remember the following complications:

- diverticulitis - manifested by symptoms of intoxication( temperature, weakness, headache), nausea, vomiting, pain in the chest, reflex disorders of stool( diarrhea, constipation),
- purulent complications -mediastinitis, fistula formation, phlegmon necrosis - characterized by a general severe condition, high fever, pain and intoxication syndrome, inflammatory changes in the general blood test,
- bleeding can develop from vessels in the wall of divasvomiting with scarlet blood or gastric contents of dark color, dark or black liquid stool,
- perforation, or perforation of esophageal wall - develops with inflammation and ulceration of the diverticulum wall with the flow of food masses into the chest cavity, manifested by severe pain in the chestand abdomen, general severe condition,
- malignant degeneration of cells of the esophageal mucosa is rare in the long-term current process.

Prevention of complications is the timely access to a doctor in the presence of appropriate complaints, as well as quality treatment and compliance with a healthy lifestyle.

Forecast.

The prognosis for uncomplicated course of the disease is favorable. In the case of complications, the prognosis for health is serious and is determined by the patient's age, the nature of the complications and the presence of concomitant pathology of other organs( heart, lungs, etc.).

Doctor therapist Sazykina O.Yu.