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Zenkers Diverticulum
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Zenker’s diverticulum occurs when a pouch forms at the back of the throat. If it goes unnoticed and untreated, food can get trapped in it and become a problem. The pouch or pocket forms above the cricopharyngeal muscle, the upper esophageal sphincter(UES). This muscle separates the throat from the esophagus. Zenker’s diverticulum is a rare condition usually occurring in older adults, and the causes are related to abnormal tightening of the UES. This abnormal function of the UES may be related to gastroesophageal reflux disease (GERD), which is often called Laryngopharyngeal reflux (LPR) when it affects the throat.

When excess food or liquid stays in the pouch, regurgitation of the pouch contents can occur. This results in the patient coughing up old food, a common symptom of Zenker’s diverticulum.  Difficulty swallowing or dysphagia, both to solid food and liquids is the main symptom. Bad breath, coughing, gurgling noises, weight loss, a change in voice are other symptoms of Zenkers diverticulum. An early symptom of LPR is frequent throat clearing. This   frequent throat clearing is significantly worsened in Zenker’s Diverticulum, especially after eating.

Zenker’s diverticulum is associated with additional diagnoses. Hernias, esophageal spasm, cancer, or gastroesophageal reflux disease are all associated with Zenkers diverticulum. Weight loss may also occur, especially when difficulty swallowing or painful swallowing is present. Treatment for this condition will be determined after an endoscopy and esophageal are performed to assess the severity of the pouch.

Smaller Zenker’s diverticula can be treated without surgery. In all cases small bites and appropriate chewing of food is important.  Drinking water after each bite can help control the symptoms for those mild and smaller cases. IIn some cases, a full liquid diet may also be helpful.

Many Zenker’s diverticulum surgeries are performed endoscopically; however,  open neck surgery may be necessary in some cases. A cricopharyngeal myotomy or sectioning of the UES is performed with the surgery in both open and endoscopic cases. Sometimes swallowing can be improved by Botox injections to the UES without surgery. Treatment options will be discussed once the patient is assessed and diagnosis and severity are determined. 

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