Pharyngeal pouch: link with reflux and oesophageal dysmotility

Abstract

Twenty patients aged 56-92 years who underwent surgical correction of pharyngeal pouches at Queen Alexandra Hospital, Portsmouth were asked to fill in a detailed questionnaire. They were then interviewed and barium swallow studies performed from 3 months to 4 years post-operatively. Nineteen patients in the sample were found to have reflux and 20 had dysmotility. These findings suggest that pharyngeal pouches are not a purely localized inco-ordination of the cricopharyngeal sphincter but are associated with a generalized oesophageal muscle dysfunction.

Upper Gastrointestinal Bleed from Esophageal Diverticula in a Patient with Dermatomyositis

“…The exact etiology of these diverticula is unknown, but it is believed to result from weakness involving the inferior posterior pharyngoesophageal wall [7]. Contributing factors include incoordination of the upper esophageal sphincter (cricopharyngeus muscle), and gastroesophageal reflux [8,9]. This leads to increased intrasphincteric pressures and mucosal out-pouching through the Killian's triangle.…”

Modern pathophysiology and treatment of esophageal diverticula

“…Belafsky et al [11] demonstrated a pharyngeal dilatation at the fluoroscopy in patients with Zenker's diverticulum suggesting a cricopharyngeal functional obstruction. Gastroesophageal reflux disease and Zenker's diverticulum may be associated in up to 95% of the cases [12]. This association may be causal and related to esophageal longitudinal muscle reflex contraction and consequent widening of the gap between pharyngeal constrictors and cricopharyngeus muscles [13] or upper esophageal sphincter spasm [14].…”

“…pH monitoring Gastroesophageal reflux disease may be associated with Zenker's [12,16], midesophageal [28], and epiphrenic [6,16] diverticula. pH monitoring is indicated in symptomatic patients to allow planning of a combined procedure or guide medical therapy.…”

Esophageal Diverticula

“…Gage -White showed a 39% occurrence of hiatal hernia in patients with Zenker 's diverticulum compared to 16% in controls, suggesting that the two disorders may be due to a common pathophysiologic phenomenon [19]. Resouly et al reported an increased occurrence of refl ux symptoms in patients with pharyngeal pouches, but did not show any objective results [20]. Some authors argue that there is no solid evidence that a direct relationship exists between Zenker 's diverticulum and gastroesophageal refl ux disease [3,21] .…”