Zenker’s Diverticulum

Zenker’s Diverticulum

What is Zenker’s diverticulum?

The esophagus, the muscular tube that connects the throat and the stomach, has a muscular sphincter at its upper end that controls the passage of food into the stomach. This upper esophageal sphincter (UES)—also called the cricopharyngeus—is a semi-circular muscle located in the neck about three inches below the Adam’s apple. To prevent the reflux of foods from the esophagus into the throat, the cricopharyngeus remains contracted and tight at most times. When a person swallows, though, it relaxes and allows food to pass through. If the muscle doesn’t relax, and food is blocked from passing into the esophagus (a condition called cricopharyngeal dysfunction), the food can push down on the muscle with enough pressure to stretch it and create a sac called a diverticulum. When a patient swallows, the food will get stuck in that sac.

What are the symptoms of Zenker’s diverticulum?

Patients with Zenker’s diverticulum have difficulty swallowing, and describe food sticking and a sensation of fullness in the neck. They may have no problem swallowing liquids, but often have difficulty swallowing solid foods. Often, 20 to 30 minutes after attempting to swallow, they’ll cough out undigested food.

How is Zenker’s diverticulum diagnosed?

Physicians diagnose Zenker’s diverticulum using a test called a barium swallow. During this test patients are asked to swallow a variety of substances that are coated with barium, a whitish paste that lights up during an X-ray, enabling the radiologist to determine how well these substances are moving through the mouth, pharynx, and esophagus. The test will show if the upper esophageal sphincter is not relaxing or if foods or liquids are blocked as they pass through the esophagus. If a Zenker’s diverticulum is present, physicians can see the outline of the sac.

How is Zenker’s diverticulum Treated?

Physicians treat Zenker’s diverticulum when it significantly affects a patient’s quality of life, or causes him or her complications such as aspiration pneumonia. The diverticulum can be treated surgically using one of two approaches. Physicians can perform the procedure through an incision made on the outside of the neck (transcervically), then remove the sac completely. More recently a minimally invasive transoral approach has become the treatment of choice.  This is an endoscopic procedure in which a physician cuts the wall that separates the sac from the esophagus. Food that goes into the sac will then flow right into the esophagus. Patients treated with this newer approach have less discomfort and a faster recovery but may have slightly higher chance of a recurrence.

What is the outlook for people with Zenker’s diverticulum

Patients who are treated for Zenker’s diverticulum have an excellent prognosis, and most patients become free of any swallowing difficulty. A small number of patients (about 20%) continue to experience some difficulty swallowing, but it does not affect their well-being. A much smaller number of patients (3% to 7%) have a recurrence of symptoms and their diverticulum and will likely need to be re-treated.