Zenker’s Diverticulum Overview

A Zenker’s diverticulum is an abnormal pouch that forms at the top of the esophagus in the back of the throat. The pouch can trap food and medications, making it difficult to swallow and increasing the risk of choking.

Also known as pharyngoesophageal diverticula, Zenker’s diverticula primarily affect older adults. While the condition is relatively rare overall, it is the most common type of esophageal diverticulum.

Zenker’s Diverticulum Causes and Risk Factors

A Zenker’s diverticulum may form if the cricopharyngeal (CP) muscle does not fully relax during swallowing, creating pressure within the esophagus. The CP muscle serves as the upper esophageal sphincter, contracting and relaxing as necessary to propel food from the mouth to the stomach. Excessive pressure in the esophagus can force a portion of its inner mucosal lining to push through its outer muscular wall, forming a pouch.

Known risk factors for Zenker’s diverticula include:

  • Advanced age – Most cases are diagnosed after age 70, possibly due to age-related muscle weakness in the esophagus.
  • Certain medical conditions – Chronic conditions that affect the esophagus, such as gastroesophageal reflux disease (GERD) and achalasia, can cause changes in its pressure dynamics.
  • Esophageal motility disorders – Conditions that affect the function of the esophagus, such as esophageal spasms and difficulty swallowing (dysphagia), can weaken its walls.
  • Lifestyle factors – Smoking and excessive consumption of alcoholic beverages have been linked to a higher risk of developing esophageal conditions, such as Zenker's diverticula.

Zenker’s Diverticulum Signs and Symptoms

A Zenker’s diverticulum may not cause noticeable symptoms unless the pouch is large enough to interfere with swallowing. Most esophageal pouches are just a few centimeters in diameter.

What Does a Zenker’s Diverticulum Feel Like?

  • Vocal hoarseness (dysphonia)
  • Phlegm buildup in the throat
  • Bad breath (halitosis)
  • Regurgitation of swallowed food
  • Aspiration pneumonia

What Does a Zenker’s Diverticulum Look Like?

In diagnostic images, a Zenker’s diverticulum may look like a pouch protruding from the esophageal wall. The pouch might contain food or liquid.

Additionally, because a Zenker’s diverticulum can interfere with the swallowing of food, it may cause visible weight loss.

Zenker’s Diverticulum Diagnosis

Proper diagnosis of a Zenker’s diverticulum is essential for effective treatment. The primary diagnostic techniques include:

  • Clinical evaluation – A physician will assess the symptoms and perform a physical examination and medical history review.
  • Barium swallow study – As X-rays are continually captured, the patient will swallow a barium contrast solution, which will coat the esophagus and enhance the clarity of the images. This can help the physician visualize the diverticulum (if present) and assess its size and location.
  • Upper endoscopy – A physician will guide a flexible tube with a miniature camera attached to the end (endoscope) through the mouth and into the esophagus. Using the endoscope, the physician can gain a direct view of the Zenker’s diverticulum (if present) and assess its severity.
  • Esophageal manometry – A physician will guide a narrow, flexible, pressure-sensitive tube (catheter) through a numbed nostril and into the esophagus. Using the catheter, the physician will measure the pressure inside the esophagus while the patient sips varying amounts of water.
  • Imaging studies – In complex cases, a physician may order advanced imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to obtain detailed views of the esophagus and surrounding structures.

Zenker’s Diverticulum Treatment

Treatment for a Zenker’s diverticulum can vary depending on the severity of the symptoms and the general health of the patient. Early diagnosis and intervention are key to effective management.

Non-Surgical Treatment

To address mild symptoms, nonsurgical treatment may be sufficient, such as:

  • Dietary modifications – It can be helpful to eat soft foods, chew thoroughly, drink plenty of water and have smaller, more frequent meals.
  • Swallowing therapy – A speech-language pathologist can help improve swallowing techniques and reduce the risk of aspiration.

Surgical Treatment

Surgery may be considered to address severe symptoms that do not respond to conservative care. Surgical treatment options may include:

  • Endoscopic diverticulotomy – During this minimally invasive procedure, a surgeon will use an endoscope to access the diverticulum. The surgeon will then separate the wall between the diverticulum and the esophagus, allowing food to pass more easily.
  • Open surgical diverticulectomy – This traditional surgical approach involves making an incision in the neck to remove the entire diverticulum. This procedure may be combined with a cricopharyngeal (CP) myotomy to relax the CP muscle at the top of the esophagus and help prevent a recurrence.
  • Stapled diverticulotomy – This precise Zenker’s diverticulum repair technique combines the use of an endoscope and a surgical stapler. In one step, the surgeon will cut and close the diverticulum, minimizing the risk of infection and promoting fast healing.

Benefit From World-Class Care at TGH

Tampa General Hospital’s Digestive Diseases Institute is a world-class center of excellence for the research, prevention, diagnosis and treatment of conditions affecting the gastrointestinal (GI) tract, including Zenker’s diverticula and other uncommon esophageal disorders. If you would like to be referred to a physician in our GERD and Esophageal Surgery Center, please call 1-800-822-3627 or use our online Physician Finder.