Diverticulum is a medical term referring to an abnormal, pouch like structure. Diverticula can form in almost all areas of the digestive tract. When a pouch forms at the junction of the oesophagus and the pharynx, it is called Zenker’s diverticulum. The pharynx is located at the back of the throat, behind the nasal cavity and mouth.
Zenker’s diverticulum appears in the hypopharynx, which is the bottommost part of the pharynx, where it joins the oesophagus (the tube that leads to the stomach). The area that Zenker’s diverticulum usually appears in is known as Killian’s triangle.
Zenker’s diverticulum is a rare condition which affects middle-aged and older adults, especially individuals in their 70’s and 80’s. This condition is known to affect more men than women.
Other names for Zenker’s diverticulum are pharyngoesophageal diverticulum, hypopharyngeal diverticulum or pharyngeal pouch.
Symptoms of Zenker’s Diverticulum
Dysphagia, which is difficulty swallowing, is the most common symptom of Zenker’s diverticulum. Other symptoms of Zenker’s diverticulum include:
- Regurgitating food or oral medication
- Halitosis (bad breath)
- Hoarse voice
- Persistent cough
- Swallowing liquids or food matter down the wrong pipe (aspiration)
- Sensation of a lump in your throat
The symptoms can worsen over time if left untreated.
Causes of Zenker’s Diverticulum
Swallowing is a complex process which requires coordination of the muscles in the mouth, pharynx and oesophagus. When you swallow, a circular muscle known as the upper oesophageal sphincter opens to allow chewed food matter to pass. After swallowing, the upper oesophageal sphincter closes to prevent inhaled air from entering the oesophageal.
Zenker’s diverticulum formation is related to upper oesophageal sphincter dysfunction. When the upper oesophageal sphincter does not open all the way, it puts pressure on a certain area of the pharynx wall. The excess pressure gradually pushes the tissue outward, causing it to form the diverticulum.
Gastroesophageal reflux disease (GERD) and age-related changes in tissue composition, as well as muscle tone are also thought to play a role in the process.
Diagnosis of Zenker’s Diverticulum
Zenker’s diverticulum is diagnosed using a test known as barium swallow. This is a special X-ray that highlights the inside of the mouth, pharynx and oesophagus. A barium swallow fluoroscopy allows your physician to see how you swallow in motion.
Sometimes, you might have other conditions present alongside Zenker’s diverticulum. Your physician might suggest additional tests to detect or rule out other conditions.
An upper endoscopy is a procedure which involves the use of a thin, camera-equipped scope to look at the throat and oesophagus. Oesophageal manometry is a test which measures pressure inside the oesophagus.
Treatment of Zenker’s Diverticulum
The Endoscopic approach
The endoscopic approach is performed through the throat using a special endoscope which passes partly into the oesophagus and partly into the pouch. The common party wall, which contains the scarred muscle fibres of cricopharyngeus, is then divided using a variety of cutting instruments. The instruments include: Endoscopic stapling devices, CO2 laser, diathermy and scalpel or scissors. The pouch itself is not removed but dividing the wall converts the pouch into part of the oesophagus/pharynx and food and debris cannot be retained but pass into the oesophagus.
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