
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
- Choking
- Hoarse voice
- Chronic cough
- Weight loss
- Aspiration of food into lungs
- Drooling or excessive salivation
- Noisy swallowing
- Weight loss
- Malnutrition
- 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.

SLIDESHOW
Super Tips to Boost Digestive Health: Bloating, Constipation, and More See SlideshowNesheiwat 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
Top Is Zenker's Diverticulum Fatal Related Articles
Beyond Food: What Triggers Heartburn and GERD?
Heartburn is the burning sensation in the chest due to backflow or reflux of the acidic stomach contents into the food pipe (esophagus). Heartburn is a major symptom of gastroesophageal reflux disease or GERD.Diarrhea
Diarrhea is a change in the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.Diverticulitis (Diverticulosis)
Most people with diverticulosis have few if any symptoms at all. When people do experience signs and symptoms of diverticulosis (diverticular disease) they may include abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Diverticulitis is a condition in which diverticula in the colon rupture. The rupture results in infection in the tissues that surround the colon. Treatment methods for diverticulitis include prescription medications, and in some cases, diverticulitis surgery.Duodenal Diverticulum
Duodenal diverticula (extramural or intramural), or duodenal diverticulum, is a pouch that is attached to the first part of the small intestine (duodenum). The cause of extramural diverticula is not clear, however, it may be congenital. Complications caused by duodenal diverticulum include rupture, gallstones, or pancreatitis. Extramural duodenal diverticula has no symptoms. Treatment is generally surgery.Esophagus Picture
The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. See a picture of the Esophagus and learn more about the health topic.GERD (Acid Reflux, Heartburn)
Gastroesophageal reflux disease (GERD), also called acid reflux, can cause symptoms like heartburn, chest pain, regurgitation, and nausea. Learn about causes, diagnosis, treatment and prevention.GERD Quiz
Who is at risk for developing GERD? Are you? Take this quiz to learn what GERD is, if you're at risk, and what you can do about it.GERD: Is the Damage Reversible?
Gastroesophageal reflux disease or GERD is caused by the weakening of the lower esophageal sphincter (LES). LES is a group of muscles that act as a valve to prevent the acidic contents of the stomach from refluxing into the esophagus.Acid Reflux (Heartburn, GERD): Symptoms & Remedies
Heartburn is a symptom of acid reflux that causes chest pain when stomach acid backs up into the esophagus. Heartburn symptoms may mimic chest pain that occurs during a heart attack. Gastroesophageal reflux disease (GERD) may produce other symptoms.Intestinal Gas and Gas Pain
Intestinal gas and painful bloating are common. Learn about what causes gas pain and how eliminating certain foods from your diet can help relieve symptoms.Swallowing Problems (Dysphagia)
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.What Causes Drooling in Older Adults?
Drooling is a common condition that affects many people. Learn the signs of drooling, what causes drooling, how doctors diagnose drooling, and what you can do to treat drooling.