Zenker’s Diverticulum is an uncommon condition that interferes with swallowing. In Zenker’s diverticulum, a pouch grows at the back of the throat where the pharynx and esophagus meet. The growth is most common in people over sixty years of age. Patients with Zenker’s Diverticulum frequently have other esophageal problems. The condition does not appear to be a hereditary one.
A Zenker’s Diverticulum develops in a potentially weak area just above the cricopharyngeus muscle, or upper esophageal sphincter. An ongoing incoordination of the muscle over a period of years causes these areas to progressively weaken and bulge out.
The most common symptom of Zenker’s Diverticulum is difficulty swallowing with regurgitation of undigested food and pills. This may occur several minutes to hours after eating. Other symptoms include:
- Bad breath
- Coughing after eating
- Feeling as though food is sticking in the throat
- Gurgling noises in the neck
- Mucus collecting in the throat
- Aspiration of food and liquid into the airways
Diagnosis is made on the basis of an upper endoscopy, a barium swallow, or a videofluoroscopy. The pouch can be quite large, with an opening even larger than the esophageal inlet itself. It is located posteriorly, usually to the left of the midline, and may descend into the chest.
Unfortunately, no medications are available to treat a Zenker’s Diverticulum effectively. Lifestyle changes make little difference.
Surgical treatment options include endoscopic minimally invasive stapling procedures or open procedures via a neck incision. In the oral approach, the party wall between the diverticulum and the esophagus is divided. Although the diverticulum is not removed, it is allowed to empty quickly and symptoms are alleviated. Patients can go home the same day or following an overnight stay.
In the open surgery, the diverticulum is resected through the neck, stapled externally, and the muscle beneath the sac is divided. This is preferred when the diverticulum is symptomatic but too small to allow the endoscopic treatment, or for those who have restricted opening of the mouth. The hospital stay is usually a day or two.
Untreated, Zenker’s Diverticulum patients will continue to struggle with swallowing problems and will face risks from malnutrition, weight loss, and pneumonia.