What Is Zenker’s Diverticulum?
A diverticulum is a small sac or pouch that forms in the digestive tract. A Zenker’s diverticulum occurs when a pouch forms at a weak spot where the pharynx (the passage in back of the throat) meets the esophagus. Zenker’s diverticulum is thought to be a disorder of the upper esophageal sphincter, the opening through which food enters the stomach. It develops when the cricopharyngeal muscle, located near the upper esophageal sphincter, doesn’t relax as it should. As a result, the upper esophageal sphincter doesn’t open properly and pressure begins to build up in the pharynx when someone swallows. If a weak spot exists in his or her pharynx, a diverticulum could develop.
The primary risk factor for Zenker’s diverticulum is age, and risks for the condition include:
- Age — Adults usually in their 70s and 80s are primarily affected.
- Chronic reflux
Up to 90 percent of people with Zenker’s diverticulum experience dysphagia, or difficulty swallowing. Other symptoms include:
- Regurgitation — When the upper esophageal sphincter doesn’t open fully, undigested food can come back up.
- Aspiration — This occurs when foods or liquids get sucked into the airway. It can lead to aspiration pneumonia.
- Chronic feeling of something in the throat — This is a sign of undigested food sitting in the throat.
- Bad breath — Undigested food in the diverticulum can cause bad breath.
- Gurgling — Some patients may hear gurgling, which occurs when air passes through the diverticulum.
- Persistent cough — Respiratory symptoms, such as cough, are common with Zenker’s diverticulum.
- Weight loss — This may result from not digesting all of one’s food.
Mild cases of Zenker’s diverticulum may require little more than changes to how an individual eats, such as chewing foods well, drinking a lot of water after meals, and eliminating high-fat, spicy and acidic foods from the diet.
Cases that are moderate to severe usually require surgery. Left untreated, Zenker’s diverticulum can worsen over time, continuing to enlarge and possibly leading to malnutrition. The following types of surgery are available, but which type is chosen depends on the pouch’s size and location.
- Cricopharyngeal myotomy — Often used for small Zenker’s diverticulum, this procedure involves cutting a muscle in the esophagus to help ease swallowing.
- Diverticulopexy with cricopharyngeal myotomy — In this procedure, surgeons attach the pouch to the wall of the esophagus, rather than removing it. It is often used for larger Zenker’s diverticulum.
- Diverticulectomy and cricopharyngeal myotomy — The diverticulum is removed entirely.
- Endoscopic diverticulotomy — One of the more common procedures for this condition, this involves surgeons splitting the wall that separates the esophagus from the diverticulum, which allows food to enter the esophagus.
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