Zenker’s Diverticulum is a pouch that develops in the upper esophagus in the back of the throat. This condition causes debilitating dysphagia, or difficulty swallowing, and regurgitation of food. If it’s left untreated, food and saliva can get trapped in it over time. The pouch forms at the beginning of the digestive tract above the cricopharyngeal muscle, which is where your esophagus and pharynx come together. It is named after Friedrich Albert von Zenker, who published a series of patients with this disorder and described its anatomic pathophysiology in 1877. The exact cause is unknown, and this condition is rare with less than 0.01% of the population diagnosed.
Zenker’s diverticulum can be diagnosed based on a combination of your dysphagia history as well as swallow evaluation tests including barium esophagram and a videofluoroscopic swallow study. These techniques can make diagnosis 100% accurate.
Symptoms
Difficulty swallowing is the most common symptom of Zenker’s. Other symptoms include:
· Weight loss
· A persistent cough, especially at night
· Regurgitation of undigested food
· Aspiration that can lead to pneumonia
· Halitosis (bad breath) due to food being stuck in the pouch
· Hoarse voice or a change in the voice
· Feeling like something is stuck in your throat
· Gurgling noises
Zenker’s diverticulum can be associated with other medical conditions including hernias, cancer of the esophagus, esophageal spasm, and gastroesophageal reflux disease.
Treatment
Treatment depends on the size and severity of the pouch. If your diverticulum is less than one-quarter of an inch in size or you don’t have bothersome symptoms, surgery may not be necessary. Mild cases can be managed by modifying your diet and how you eat your food. Be sure all food is completely chewed before swallowing and drink water after to flush down any food that may be stuck in your throat. Cutting out spicy and acidic foods can also help reduce symptoms as well as avoiding foods that easily get stuck in the throat such as nuts.
More serious cases will require surgery that can help with difficulty swallowing, coughing, and aspiration. For large diverticulums, or for those in complicated positions, open neck surgery may be the best way to remove the pouch. Another surgical method is a divertculopexy with cricopharyngeal myotomy. This procedure requires your doctor to attach the diverticulum to the wall of the esophagus. A diverticulectomy and cricopharyngeal myotomy are when the pouch is completely removed. For smaller diverticulums, there are less invasive methods as well including a cricopharyngeal myotomy. For this surgery, the doctor will cut one of the muscles in the esophagus, making it easier to swallow.
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