Zenker's diverticulum (ZD) is a benign, rare condition that can have a significant impact on your quality of life because it impairs your ability to swallow food and liquids if left untreated. It not only is unpleasant but also can be dangerous, since this condition increases the risk of choking while eating and aspiration pneumonia (which is uncommon but a serious, life-threatening illness).
Treatment is necessary for Zenker's diverticulum even if the pouch is small. Except for surgery, there are no medications that treat the condition. However, some patients may improve with dietary modifications, such as staying off solid foods.
What is Zenker's diverticulum (ZD)?
Zenker's diverticulum is a condition in which a muscle at the top of the esophagus, called the cricopharyngeal muscle (CP), does not completely or quickly relax while swallowing. This causes the food bolus to be pushed against the esophageal wall at the CP muscle, causing an outpouching around the upper throat (Killian’s triangle). With swallowing, this pouch can collect food, causing a variety of symptoms. When it empties later, it causes coughing, choking and a constant feeling of something being stuck in the throat.
Although asymptomatic in the early stages, most people with Zenker's diverticulum have symptoms, which become more prominent as the disease advances and the diverticulum grows. The size of Zenker's diverticulum can grow, making the symptoms worse.
The common symptoms of Zenker’s diverticulum may include:
- Difficulty swallowing
- The sensation of swallowed material striking the throat
- A feeling of fullness or lump in the throat
- Halitosis or bad breath
- Hoarse voice
- Chronic cough
- Weight loss
- Aspiration of food into lungs
- Drooling or excessive salivation
- Noisy swallowing
- Weight loss
- Food regurgitation, which might begin several hours after a meal
- Other serious illnesses
- When food gets into the lungs, the patient can develop serious illnesses, such as pneumonia and bronchitis.
What are the causes of Zenker's diverticulum?
Zenker's diverticulum is a pouch at the back of the throat and above the cricopharyngeal muscle (where the pharynx and esophagus join). The cricopharyngeal muscle malfunctions by failing to open smoothly at the right time. Therefore, the pharynx's posterior wall develops a pouch. Food and saliva may accumulate in this pouch over time, causing it to expand in size.
- The condition is more common in men older than 50 years old, and it affects men more frequently than women.
- In a few circumstances, there may be a problem with the upper valve of the esophagus, causing Zenker's diverticulum. As a result, there is too much pressure in the throat, resulting in the formation of a pouch.
- Some doctors believe that gastroesophageal reflux disease (GERD) can alter esophageal tissue and muscles, increasing the risk of this problem.
Zenker's diverticulum is frequently diagnosed using a radiographic study called a barium swallow. Swallowing the radiopaque liquid barium reveals the contour of the esophagus and throat during this study. A lateral (sideways) image of the barium swallow reveals the Zenker's diverticulum when this liquid is swallowed.
How is Zenker's diverticulum treated?
There are no medications available to treat Zenker's diverticulum now. The primary therapeutic approach is surgery, which involves cutting the cricopharyngeal muscle. After the muscle has been cut, food can easily enter the esophagus without getting obstructed.
There are several types of surgery to correct a Zenker's diverticulum, including:
- Open surgery
- An incision is made in the neck, and the pouch is either completely removed or tacked upside down to prevent it from filling.
- To prevent a recurrence, the muscle just below the diverticulum is cut as part of the procedure.
- Endoscopic or transoral repair
- Metal tubes are used to insert a stapling device through the mouth.
- The muscle between the pouch and the esophagus is divided. Then, the pouch becomes a part of the upper esophagus.
- One method is to cut the muscle through the mouth with a laser, which is the best option for patients who have a small diverticulum.
- These procedures do not necessitate an incision, which means they are faster, equally effective and reduce the risk of complications, as well as hospitalization time.
Most patients will only require an overnight hospital stay and can resume normal activities soon. Diet is gradually introduced over the next few weeks. Although Zenker's diverticulum cannot be prevented, there are effective and safe treatment options available. The doctor will help determine the best treatment option based on the person’s specific situation.
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Nesheiwat Z, Antunes C. Zenker Diverticulum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK499996/
UCLA Health. Zenker’s Diverticulum. https://www.uclahealth.org/esophageal-center/zenkers-diverticulum
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