Sinus & Allergy

What is Zenker’s Diverticulum?

written by Collin County ENT

Difficulty swallowing is a condition that can affect the elderly population as well as younger individuals.

If you or a loved one has noticed discomfort or problems when swallowing food, then it might be a sign of Zenker’s Diverticulum.

What is Zenker’s Diverticulum?

The formal name for Zenker’s Diverticulum is “hypopharyngeal diverticulum.” This condition affects the Killian’s Triangle – which is the junction of the esophagus and the lower part of the throat (hypopharynx).

The term “diverticulum” means an abnormal structure with a pouch-like shape. This problem can form in almost any area of the digestive tract.

When a person has Zenker’s Diverticulum, a pouch forms at this junction as described above. This space can result in problems due to trapped food, which can cause choking and/or aspiration.

What Causes Zenker’s Diverticulum?

It is estimated that Zenker’s Diverticulum affects less than .11% of the population. The most common risk for this health condition is age.

Typically, the diagnosis only happens for older adults, with the highest risk for people in their 70s and 80s. It is rare for people under the age of 40 to be diagnosed with Zenker’s Diverticulum. Additionally, men have a higher risk than women.

When you swallow, a coordinated response happens in the mouth, pharynx, and esophagus.

First, the food is chewed, then the upper esophageal sphincter opens when you swallow so the food can move down the digestive tract. After you are done swallowing, then the sphincter closes to reduce the risk of inhaled air from moving into the esophagus.

If there is a problem with the upper esophageal sphincter, then it can cause Zenker’s Diverticulum. For example, if the sphincter doesn’t fully open, then it puts pressure on the pharynx wall.

Over time, the tissue is pushed outward, which results in the formation of Zenker’s Diverticulum.

Some doctors have also found that gastroesophageal reflux disease (GERD) can change the esophageal tissue and muscles, which can increase the risk of this problem.

Symptoms of Zenker’s Diverticulum

  • Difficulty swallowing
  • Food getting stuck while swallowing
  • Regurgitating food
  • Persistent cough
  • Bad breath
  • Aspiration
  • Swallowing “down the wrong pipe”
  • Feeling of a lump in the throat
  • Hoarse voice

Diagnosis and Lifestyle Changes

When Zenker’s Diverticulum is left untreated, it is common for the symptoms to worsen over time. The best thing you can do is talk to an ENT about treatment options.

Before a treatment plan is designed, it is important to first diagnose the condition.

Your ENT might recommend a barium swallow test, which involves x-ray technology and contrast dye so the doctor can see the motion of your swallow.

Another possible recommendation is to do an upper endoscopy, which involves using a small camera on a thin scope that gives the doctor a full view of the throat and esophagus.

If you have a mild case of Zenker’s Diverticulum, then immediate treatment isn’t necessarily required. It might be recommended that you “wait and see” instead of jumping into a big treatment.

Dietary and lifestyle changes can reduce symptoms. For example, your ENT will provide guidelines such as reducing the quantity of food eaten during each meal, chewing everything thoroughly, or drinking water between bites to wash the food down.

Are Surgical Treatments Needed for Zenker’s Diverticulum?

When a patient has a moderate or severe case of Zenker’s Diverticulum, then surgery might be the only treatment option. In most cases, the surgery can be completed using a flexible endoscopy in an out-patient procedure. It’s possible that the procedure will need to be repeated in the future if recurring symptoms are a problem.

If the diverticulum is too large or endoscopy isn’t possible, then open surgery is the next option. This procedure is completed under general anesthetic. A small incision is made in the neck, then the diverticulum is separated from the esophageal wall. Other surgical procedures might involve changing the diverticulum position and sewing it back into place.

Potential Complications if Left Untreated

When Zenker’s Diverticulum is left untreated, it can lead to a variety of complications. The diverticulum will likely increase in size, causing the symptoms to continue worsening with time. Eventually, the symptoms become so severe that it is difficult to swallow food and regurgitation is a common experience. Malnutrition can be the result.

Another serious complication is an aspiration. If food is inhaled into the lungs instead of moving down the esophagus, then it could result in pneumonia (an infection in the lungs). Other possible complications of Zenker’s Diverticulum include choking, esophageal obstruction, bleeding, paralysis of the vocal cords, or squamous cell carcinoma.

Talk to an ENT for Personal Recommendations

The best thing that you can do is schedule a consultation with an ENT to discuss your health concerns. Do you live in Collin County or near the Denton or Dallas areas? Then contact our experienced team at Collin County Ear, Nose, and Throat. We have two offices in Frisco and Plano, TX. An online form is a fast, easy way to request an appointment, or you can call the office with your questions: (972) 596-4005.

Visual Aid Description:

This infographic can be designed using the bullet points from this subheading: Signs of Zenker’s Diverticulum.

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