Zenker diverticulum


Zenker diverticulum

Description, Causes and Risk Factors:

A diverticulum is a pouch or sac that is created by herniation of a muscle wall. Zenker's diverticula are pouches that develop in the pharynx just above the upper esophageal sphincter. Food may become trapped there, causing difficulties in swallowing, bad breath, regurgitation, and irritation. Zenker diverticulum generally are categorized as small, intermediate, or large in size. They extend into the left side of the neck 90% of the time due to a slight convex shape of the esophagus to that side and the presence of a potential space there.

In Zenker's diverticula, there is a splitting between muscles in the pharynx. Most often this split occurs in an area known as Killian triangle, although other areas are possible as well. The cause of Zenker's diverticulum is not known, but theories include the following:

    Abnormal timing during swallowing that causes the cricopharyngeal muscle to close when it should open.

  • Incomplete relaxation of the cricopharyngeal muscle.

  • Loss of elasticity in the cricopharyngeal muscle.

  • Cricopharyngeal muscle myopathy or atrophy.

  • Central nervous system injury.

  • Cricopharyngeal muscle spasm caused by gastroesophageal reflux disease (GERD).

  • Abnormalities in the upper esophageal sphincter.

Zenker's diverticula occur most often in northern European countries and those whose heritage is European, including the US, Canada and Australia. It is rare in Asia. It is one and a half times more common among men than women, and almost always occurs in older individuals.

If Zenker's diverticulum is left untreated, patients will continue having difficulty swallowing. The risks associated with having Zenker's diverticulum are weight loss, malnutrition, and pneumonia caused by food entering the lungs from the pouch. Although uncommon, these can be life-threatening.

Symptoms:

Symptoms of Zenker's diverticulum may include:

    Swallowing problems (dysphagia).

  • Regurgitation of undigested food hours after eating.

  • Feeling of food sticking in the throat.

  • Coughing after eating.

  • Aspiration of food and liquid into the airways.

  • Unexplained weight loss.

  • Bad breath.

  • Gurgling noises in the neck.

Diagnosis:

Zenker diverticulumis generally diagnosed by means of a barium swallow, which is also called a contrast esophagram. For this test, you will drink a barium-containing liquid, which coats the inside of the esophagus and makes its shape and contours appear on x-rays. The x-ray technologist may take a series of images.

Other tests your physician may prescribe for you include:

    Endoscopy. You will be given a relaxing medication intravenously (in a vein) and the surgeon or gastroenterologist will numb the back of your throat and examine the upper esophagus with an endoscope.

  • Esophageal manometry. This test measures the pressure inside the lower esophageal sphincter, and may be used if your physician suspects an esophageal movement disorder.

A physical examination and patient history are also important parts of diagnosis.

Treatment:

If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope. Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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