esophageal diverticulum - Causes, Symptoms and Treatment .MF .
not everyone has a clear idea of what the diverticulum of the esophagus.The more frightening, the term can be for looks absolutely healthy person passing a scheduled scan, for example, and having no complaints on the part of the digestive system.What is it, what symptoms and when treatment is required diverticulum?
diverticulum - is an abnormal bulging of the wall of the hollow body, represented by all three (mucous, muscular and serous) or only one (mucous) membranes.If such sacciform education located in the esophagus wall, then one speaks of esophageal diverticulum.In the first case of esophageal diverticulum is considered true, and in the second - false or pseudodiverticulum when there is protrusion of mucosa through the opening between the weak muscles of the esophagus.
itself diverticula disease is difficult to call, because they do not always manifest his presence of unpleasant symptoms.About the disease as such it is in cases of multiple formations in the wall of the esophagus, as well as in
The most common esophageal diverticulum occurs in men over 45 years, subject to diseases of the gastrointestinal tract.In addition, a feature of the structure of the esophagus may be congenital and does not cause discomfort throughout a person's life.
In most cases, diverticula can be single, but about 10% of all cases are reported multiple diverticula of the esophagus.Bulging can be formed in any esophagus - in the neck part (pharyngoesophageal or Zenker's diverticulum), chest (srednepischevodny and epiphrenic diverticulum) or ventral (subdiaphragmatic diverticulum).Most occur in the thoracic diverticulum esophagus.
Causes of esophageal diverticula.
Causes of congenital diverticulum occurring during fetal development are harmful factors affecting the fruit - poor nutrition and bad habits of the future mother, stress, early and late toxicosis of pregnancy, adverse environmental conditions.
reasons for the acquisition, that is developed in the course of life, diverticulum, are usually gastrointestinal disease:
- Esophagitis - an inflammatory disease of the esophagus, especially long-flowing,
- gastro-oesophageal reflux - casting of gastric contents into the esophagus withmucosal lesions of the esophagus acidic gastric juice shell,
- peptic ulcer,
- achalasia and cardiospasm - abnormal narrowing of the gastroesophageal sphincter with increased pressure in the esophageal lumen,
- esophageal injury and stomach,
- inflammatory and neoplastic diseases of the mediastinum bodiesinvolvement in the process from the outside wall of the esophagus - tuberculosis of intrathoracic lymph nodes, mediastinitis, adhesions in the mediastinum and other
diverticula Clinical manifestations vary and are determined by location and size of protrusions.For example, the small size of diverticulum, located in the thoracic esophagus can does not manifest itself throughout a person's life if not exposed to the inflammatory process in it - diverticulitis.
Bulging, localized in the abdominal esophagus and in the transition zone in his stomach, symptoms may appear from the cardiovascular system because of the nature of the innervation area.These symptoms include tachycardia, shortness of breath, pain in the heart, ECG changes.
most severe clinical symptoms have diverticula pharyngoesophageal area, or Zenker's diverticulum.The main symptoms include:
- dysphagia syndrome, or disorders of swallowing food, mostly solid,
- regurgitation syndrome, or frequent vomiting eaten on the eve of the food, especially at night in a horizontal position,
- sensationlump in the throat, even in between meals,
- a sense of rawness, tickle in the throat, frequent coughing and choking,
- frequent bronchitis, laryngitis due to inhalation (aspiration) of food pieces from the diverticulum and in connection with dysphagia,
- nausea, excessive salivation.
When one or more of the above symptoms should consult a doctor for examination.
After clarification of the patient's complaints and inspection, in which can be markedly rounded education in the neck in the event of a diverticulum Zenker, the doctor prescribes additional diagnostic methods, which include the following:
- radiopaque study of the esophagus and stomach with contrasting suspension of barium- the main feature is leaking the contrast into the cavity of a diverticulum, on the radiograph indicated by the arrow:
- esophagoscopy necessarily be carried out in all patients with suspected lesions wall of the esophagus, allows visualization of the mucosa of the esophagus and determine the localization of diverticula, and if necessary in the event ofpathology hold fence pieces esophageal tissue with subsequent histological examination (biopsy),
- ezofagomanometriya- measurement of pressure in the lumen of the esophagus - showing people with gastroesophageal reflux disease and achalasia,
- MRI or CT scan of the esophagus to allow a more precise assessment of the nature and localization of the pathological processesophageal, mediastinal organs and lymph nodes of the chest cavity,
- consulting cardiologist, ECG, ECG monitoring and blood pressure are held for the purpose of differential diagnosis of heart disease and blood vessels.
decide on the appointment of those or other methods of examination should be a doctor.
Treatment of esophageal diverticula.
diverticula Treatment is performed using conservative or surgical methods.Completely get rid of the diverticulum conservative way possible, but prevent new on the background of the underlying disease of the gastrointestinal tract and improve the quality of life is feasible.
conservative methods include:
- dieting and nutrition,
- reception before the meal one to two teaspoons of vegetable oil (sunflower or olive),
- reception, which is used straining after every meal - this timeincreased intra-abdominal and intrathoracic pressure, promoting the expulsion of food debris from the oral diverticulum into the esophagus,
- gargling after meals with warm water, zapivanie food with plenty of water, sometimes with the addition of dilute solutions of antiseptics (potassium permanganate, furatsilin), and the adoption of certain postures,in which the patient feels relief of symptoms associated with food intake,
- drug therapy of the underlying disease, such as the appointment of proton pump inhibitors (omeprazole), blockers of H-2 receptor (famotidine, ranitidine), drugs that reduce gastric acidity (antacids - Rennie, almagel) with gastroesophageal reflux disease, in addition to the antibiotics (amoxicillin, metronidazole) for stomach ulcers, and so on. d.
Surgery strictly shown in the development of complications, as well as in the case of diverticula large, causing the appearance of pronouncedclinical symptoms.Operation is excision of the diverticulum wall with subsequent diaphragmatic flap plasty of the esophagus, or reposition of a diverticulum in the lumen of the esophagus, followed by suturing of the esophageal wall.Identify indications and contraindications for surgery can only be a doctor after all the necessary diagnostics.
Lifestyle with esophageal diverticulum.
Compliance with recommendations for a healthy lifestyle in many ways improves the quality of life and prevent complications.These recommendations include the following:
- complete rejection of bad habits,
- observance of the regime of work and rest with sufficient sleep at night,
- sleep with elevated headboard,
- adherence power with frequent fractional eating small meals in a warmform (to eliminate hot and cold food),
- cooking in the steam, stew or baked form,
- exclusion of junk food - fast food, fried, fatty, salty foods, canned food, spices, chocolate, coffee,
- limitsweet and flour products, fresh dairy products (fat milk, cream),
- supplementation beneficial foods - cereals, fresh fruit and baked, stewed vegetables, dairy products, vegetable oils, etc.
Complications esophageal diverticula..
Subject to the main recommendations for the treatment of complications are rare.Nevertheless, the patient should be aware of the following complications:
- diverticulitis - is manifested symptoms of intoxication (fever, weakness, headache), nausea, vomiting, chest pain, reflex impaired stool (diarrhea, constipation),
- suppurative complications- mediastinitis, fistula formation, abscess of the neck - characterized by severe general condition, high fever, pain and intoxication syndrome, inflammatory changes in the blood count,
- bleeding can occur from the vessels in the wall of a diverticulum, it is characterized by vomiting red blood or stomach contents of the darkcolor, dark or black stools,
- perforation or perforation of the esophagus wall - develops when the inflammation and ulceration of the wall of the diverticulum to the expiration of the food mass in the chest cavity, manifested severe pain in the chest and abdomen, severe general condition,
- malignant transformation of cellslining of the esophagus is rare at this long process.
prevention of complications is timely access to a doctor with appropriate complaints, as well as the quality of treatment and adherence to a healthy lifestyle.
prognosis for uncomplicated disease favorable.In the case of health complications for the forecast seriously and is determined by the patient's age, the nature of the complications and the presence of concomitant diseases of other organs (heart, lungs, and so on. D).
therapists Sazykina OJ