Causes

Esophageal diverticula develop from weakened esophageal musculature (congenital and acquired), traumatic injury, and scar tissue associated with chronic inflammation. Developmental muscle weakness of the posterior pharynx above the border of the cricopharyngeal muscle leads to Zenker's diverticulum. Pressure caused by swallowing and contraction of the pharynx before the sphincter relaxes aggravates the muscle weakness and results in the development of diverticula. A response to scarring and pulling on esophageal walls by an external inflammatory process such as tuberculosis or by traction from old adhesions may lead to midesophageal diverticula. Other causes of esophageal diverticula include motor disturbances such as achalasia (absence of normal peristalsis in esophageal smooth muscle and elevated pressure at the physiological cardiac sphincter), diffuse esophageal spasms, and reflux esophagitis.

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