A diverticulum is a pouch or sac that opens from a hollow organ such as the esophagus. The esophagus is the tube connecting the mouth with the stomach. Zenker’s diverticulum can occur anywhere in the esophagus but is usually found in the upper part. The lining of the esophagus pushes backward, so some food stays in the pouch rather than moving down into the stomach.
Zenker’s diverticulum is rare, occurring in less than 0.01% of the population. It’s found more often in women than in men, usually those 60 years old or more.
This disorder can be associated with hiatal hernias, esophageal spasm, gastroesophageal reflux disease, and, rarely, cancer of the esophagus.
The cause is unknown, but it may result from increased pressure in the esophagus. This pressure may occur if the esophagus doesn’t relax completely when food is swallowed. The pressure leads to a tear or break (herniation) in muscle tissues lining the esophagus. The result is a diverticulum. Zenker’s diverticulum isn’t passed from parents to children and isn’t contagious.
The most common complaint is trouble swallowing (called dysphagia) solids and liquids. Coughing, bad breath (halitosis), weight loss, fullness in the neck, and spitting up undigested food are others.
An untreated diverticulum becomes larger and can lead to complications. These include food getting into lungs (aspiration), shortness of breath, fever, and pneumonia.
The health care provider makes a diagnosis by taking a medical history and ordering a barium swallow. In this test, barium contrast material is swallowed and x-rays are taken to get pictures of the esophagus.
The health care provider may suggest seeing a gastroenterologist (doctor specializing in disorders of the esophagus, stomach, and intestines). The gastroenterologist may want to do a test called endoscopy. In this test, a scope with a lighted end is inserted into the mouth and passed through the esophagus into the stomach. Endoscopy will confirm the diagnosis and can also look for other disorders such as ulcers, abnormal tissue, and cancer in the esophagus.
Surgery is the recommended treatment for people with symptoms. For people without symptoms and with a small diverticulum (less than ¼ inch), treatment may be conservative. This means that the health care provider will wait for symptoms to occur before doing surgery.
Surgery helps dysphagia, cough, and aspiration in almost all people.
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