Zenker's Diverticulum

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Introduction

Zenker’s diverticulum is a rare condition that causes a pouch to form in the lower walls of the throat.  The condition can lead to problems with swallowing and cause coughing, choking, and bad breath.  Although the cause of Zenker’s diverticulum is unknown, it can be corrected with traditional surgery or advanced procedures that do not even require an incision.
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Anatomy

Swallowing is a complex process that involves a series of steps.  When you eat, your tongue moves moistened chewed food (bolus) to the back of your mouth to trigger the swallowing reflex.  When you swallow, the food moves into the first part of your pharynx (oropharynx).  The pharynx is a tube-like passageway that contains the tracts for breathing and digestion.  Automatic muscle contractions move the food from the pharynx to the esophagus.  The esophagus is the tube that carries food to your stomach for digestion.
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Causes

The exact cause of Zenker’s diverticulum is unknown.  It appears that the condition results from excessive pressure on a weak spot of the pharynx wall that causes it to balloon out and form a pouch (diverticulum).  The pouch may be as large as a few centimeters.

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Symptoms

Zenker’s diverticulum may or may not cause symptoms.  It may be difficult to swallow if food has collected in the pouch.  You may feel like you have a lump in your throat, but pain does not usually occur.  You may experience coughing, choking, or spitting up food, especially when you lie down.  Additionally, Zenker’s diverticulum can cause bad breath.
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Diagnosis

Your doctor can diagnose Zenker’s diverticulum by reviewing your medical records, examining you, and conducting some tests.  A barium swallow (upper GI series) and upper endoscopy are frequently used imaging test to help your doctor check for a pouch and confirm the diagnosis. 
 
For the barium swallow, you will swallow barium before a series of X-rays are taken.  An upper endoscopy is another test that is used to allow your doctor to view your throat.  After you receive a relaxant, your doctor will place an endoscope through your mouth and into your esophagus.  An endoscope is a long thin tube with a light and a viewing instrument that sends images to a monitor.
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Treatment

Surgery is recommended to correct the pouch when symptoms become bothersome.  The type of procedure you receive may depend on the extent of your symptoms and the size of the pouch.  Traditional open surgery may be used to treat large pouches.  Open surgery accesses the pouch through an incision in the neck and requires a few days in the hospital for recovery.  Endoscopic procedures are an alternative to open surgery.  Endoscopic procedures do not require an incision because they are performed with an endoscope that is inserted through the mouth.  The endoscope guides the surgery, which may use laser treatment or staples to correct the pouch.  The endoscopic procedure is performed as an outpatient procedure and is associated with fewer complications and a quicker recovery time.
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Am I at Risk

Zenker’s diverticulum most frequently develops in adults over the age of 50.  Because a specific cause has not been identified, specific risk factors are not known at this time.
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Complications

People with Zenker’s diverticulum may experience problems swallowing pills.  The pills may become lodged in the pouch instead of moving onto the stomach for absorption.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.