Zenker's Diverticulum – Causes, Symptoms, Diagnostic Tests, Complications and Treatment

Zenkers Diverticulum

, or its synonyms pharyngoesophageal diverticulum or pharyngeal pouch, essentially refer to the diverticulums or outpouching of the mucous lining of the pharynx. The precise location would involve the portion of the pharynx above the cricopharyngeal muscle or the starting point of the sphincter muscle in the esophagus. It is termed a false diverticulum as it does not include all the layers of the esophageal wall.

Pharyngeal pouches are mostly seen in patients above 70. The reason is believed to be the loss in elasticity of the upper esophageal sphincter muscle resulting in a faulty contraction and relaxation of the muscle causing a narrowed and restricted opening for the food to pass through. Excessive pressure in the lower portion of the pharynx causes the weakened portion of the esophageal wall to bulge out.

Zenker's Diverticulum

Symptoms of the condition

  • Dysphagia (Increased difficulty in swallowing food).
  • Sensation of a lump in the throat.
  • Regurgitation of swallowed undigested food.
  • Intense cough as food may get into the airways too.
  • Halitosis or smelly breath caused by the undigested food which has been worked upon by the microorganisms.
  • Swallowing may be accompanied with gurgling noises.
  • A visible lump or protrusion in throat.
  • Choking while asleep.
  • Esophageal webs are present in about 50% of patients having this condition.

Diagnostic tests to detect the condition

  • A barium swallow test will reveal the pouches in the esophagus.
  • An endoscopy may have the associated risk of perforating the esophageal wall.


  • Complications of the condition include pneumonia, bronchiectasis and lung abscess.

Treatment of Zenker’s Diverticulum

  • If the diverticulem is small and without any symptoms then treatment is not necessary.
  • Larger ones with symptoms need to be attended surgically. Opening the pharynx and resecting the balooned walls of the esophagus through an incision in the cricopharyngeus muscle is often the drill.
  • However, non surgical techniques are getting immensely popular. They involve stapling the diverticulum with the help of an endoscope.
  • Webs and rings are mostly treated with dilation.

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