The esophagus is a dynamic neuromuscular tube suspended in the chest between its muscular attachments in the neck above and the diaphragm and phrenicoesophageal ligament below. It is served by smooth and striated muscle divided into 2 layers and by enervation from the voluntary and involuntary nervous systems. It is a pressure-developing chamber that must work efficiently in pressure gradients ranging from atmospheric in the pharynx to negative in the chest to positive in the abdomen. Food is discharged into the esophagus by voluntary contraction of the pharyngeal muscles, and is then carried to the stomach by precise smooth muscle integration. Derangement of this integrated function may lead to the formation of esophageal diverticula.
There has been much discussion related to the etiology of esophageal diverticula, but very little objective evidence for the standard theories of causation has been forthcoming. It is almost too elementary to mention that the usual
CROSS FS, JOHNSON GF, GEREIN AN. Esophageal DiverticulaAssociated Neuromuscular Changes in the Esophagus. Arch Surg. 1961;83(4):525-533. doi:10.1001/archsurg.1961.01300160037005