Zenker’s Diverticulum

Zenker’s diverticulum is a pouch that develops in your throat. It can make swallowing difficult. The pouch forms when your cricopharyngeus muscle, which is the upper sphincter muscle of the esophagus, doesn’t work like it should. Constant pressure from this muscle creates back pressure on the wall of your throat.

Over time, that pressure may push tissue through the throat wall to make a pouch or outpouching. The pouch may cause issues like difficulty swallowing, regurgitating food or bad breath. Medical treatment is surgery to remove or open the diverticulum. Changing how you eat may ease Zenker’s diverticulum symptoms.

Symptoms of Zenker’s diverticulum

Symptoms may vary depending on the size and location of the pouch (diverticulum). For example, you may not have symptoms unless the pouch gets big enough to affect your ability to swallow food. Symptoms may include:

• Aspiration pneumonia. Some of the food or phlegm may go down your windpipe and cause an infection.
• Bad breath (halitosis). Food trapped in the pouch can start to decay, so your breath smells bad.
• Bringing up food/phlegm. You may bring up (regurgitate) swallowed food. This can happen if the pouch fills up with food that then spills back into your throat.
• Difficulty swallowing (dysphagia). This may happen if the pouch grows large enough to partially block your throat.
• Globus sensation. This is the feeling that there’s something stuck in your throat. It may happen if the pouch grows large enough to push on your cricopharyngeus muscle, your upper esophageal sphincter or tissues in your throat.
• Hoarseness (dysphonia). This can happen if a pouch pushes on your recurrent pharyngeal nerve. This nerve controls your larynx and voice box. Pressure on the nerve can cause hoarseness.
• Unintended weight loss. You may lose weight because you can’t swallow food.

Zenker’s diverticulum causes

Zenker’s diverticulum happens when your cricopharyngeus muscle doesn’t relax like it should. Normally, this muscle constantly squeezes your upper esophageal muscle to close off your esophagus. It relaxes when you swallow food so that food can move from your throat into your esophagus. When this muscle doesn’t relax, your upper esophageal sphincter doesn’t open as much as it normally does.

At the same time, powerful muscles in your throat push food down toward your cricopharyngeus muscle. The combination puts pressure on the walls of your throat.

In Zenker’s diverticulum, that pressure can push tissue through a weak spot in your throat to make a pouch or outpouching (diverticulum). The pouch affects how food moves from your throat into your esophagus.

Experts don’t know what causes the cricopharyngeus muscle to tighten when it should relax.

Risk factors

Risk factors for developing Zenker’s diverticulum include:

• Age. The condition typically affects people ages 70 to 90.
• Sex. Males are more likely to develop it.
• Esophageal dysmotility. These are conditions that affect how your esophagus works.

Complications of Zenker’s diverticulum

The condition may cause complications that include:

• Aspiration pneumonia. This is a bacterial infection in your lungs. It can happen if you inhale regurgitated food that spills out of the pouch.
• Malnutrition. You may develop malnutrition if the diverticulum keeps food from going through your digestive system.

How doctors diagnose Zenker’s diverticulum

A healthcare provider will do a physical exam. They’ll ask about your symptoms. They may ask if you have a type of esophageal dysmotility. They may refer you to a gastroenterologist for tests, including:

• Esophageal manometry test to check how your esophagus works
• Esophagram (barium swallow) so your provider can see your esophagus in action when you swallow
• Upper endoscopy so your provider can look at the inside of your esophagus

How is Zenker’s diverticulum treated?

Treatment is usually surgery to remove or fix the pouch so you can swallow. Your gastroenterologist may recommend surgery if the pouch causes serious complications like malnutrition or aspiration pneumonia. But not everyone who has Zenker’s diverticulum will need surgery. There are different types of surgery to treat it:

• Open surgery. This procedure involves making cuts in your throat.
• Endoscopic surgery. In this procedure, your provider inserts small instruments into your mouth. They use the instruments to fix or remove the pouch.
• ZPOEM. POEM refers to peroral endoscopic myotomy. This procedure treats Zenker’s diverticulum by stretching your cricopharyngeus muscle.

Your gastroenterologist will discuss surgery options so you can both decide on what makes sense in your situation.

Recovery time

Your recovery time will be different depending on the type of surgery you have. In general, it takes longer to recover from open surgery than endoscopic or ZPOEM surgery. Your gastroenterologist will explain what you can expect, but the recovery process typically includes:

• Staying in the hospital for at least a day, up to several days
• Being on a liquid or soft diet for two days up to two weeks after your surgery
• Temporarily needing a feeding tube in your nose if you had open surgery, so the surgical wound can heal

What are surgery complications?

Open and endoscopic surgery have similar potential complications:

• Bleeding
• A leak or hole in your esophagus (esophageal rupture)
• Infection in your neck or chest (mediastinitis)
• Injury to your lips, teeth, tongue or gums from endoscopic surgery
• Hoarseness if open surgery damages the nerve in your larynx (voice box)

When should I seek care?

You should talk to a healthcare provider if you have swallowing issues that don’t go away. If you have surgery for Zenker’s diverticulum, contact your gastroenterologist if you have infection symptoms like fever or pus coming from the incision.

Treatment may cure this condition. But Zenker’s diverticulum can come back. Ask your gastroenterologist about which symptoms may mean that there’s a new pouch in your throat.

Is there anything I can do to feel better?

Zenker’s diverticulum can make it hard for you to swallow food. You may feel like food is getting caught in your throat. Here are some steps that may help move food past the pouch:

• Take small bites of food
• Chew each bite very thoroughly
• Sip water between bites of food
• Avoid foods that could get caught in the pouch, like seeds and nuts, or food with skin, like apples and tomatoes