Oesophageal pouch

Oesophageal pouches are abnormal dilations or sac-like protrusions of the oesophagus, which is the muscular tube that carries food and liquids from the mouth to the stomach. These pouches can occur at any point along the oesophagus but are most commonly found in the upper or lower sections. The condition can lead to a variety of symptoms and complications, depending on the size and location of the pouch.

Types

There are two main types of oesophageal pouches, which are classified based on their location and underlying cause:

• Zenker's Diverticulum: This is the most common type of oesophageal pouch, occurring at the upper part of the oesophagus. It is believed to be caused by increased pressure inside the oesophagus, often due to dysfunction or weakness of the oesophageal muscles.
• Epiphrenic Diverticulum: These pouches are found near the lower end of the oesophagus, above the diaphragm. They are often associated with conditions that increase pressure within the lower oesophagus, such as achalasia or gastroesophageal reflux disease (GERD).

Symptoms

Symptoms of oesophageal pouches can vary widely, ranging from none at all to severe, depending on the size and location of the pouch. Common symptoms include:

• Difficulty swallowing (dysphagia)
• Regurgitation of undigested food
• Coughing or choking, especially when lying down
• Bad breath (halitosis)
• Weight loss
• Chest pain or discomfort

Diagnosis

Diagnosis of oesophageal pouches typically involves a combination of medical history, physical examination, and diagnostic tests, including:

• Barium swallow: A special X-ray test where the patient swallows a barium solution to provide clear images of the oesophagus.
• Endoscopy: A procedure that uses a flexible tube with a light and camera to view the inside of the oesophagus.
• Manometry: A test to measure the pressure and muscle contractions inside the oesophagus.

Treatment

Treatment for oesophageal pouches depends on the size of the pouch and the severity of symptoms. Options include:

• Dietary changes and eating smaller, more frequent meals
• Endoscopic procedures to remove or reduce the size of the pouch
• Surgery, in more severe cases, to remove the pouch and repair the oesophagus

Complications

If left untreated, oesophageal pouches can lead to complications such as:

• Aspiration pneumonia, due to food or liquid entering the lungs
• Malnutrition or dehydration, due to difficulty swallowing
• Oesophageal ulcers or bleeding

Prevention

There is no specific way to prevent oesophageal pouches, but managing underlying conditions that increase the risk, such as GERD or achalasia, can help reduce the likelihood of developing pouches.