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What Is Zenker's Diverticulum?

Medically Reviewed by Dan Brennan, MD on June 05, 2021

Zenker’s diverticulum is a pouch that can form at the back of your throat. If it's left untreated, food and saliva can become trapped in it over time. Learn more about the symptoms of Zenker’s diverticulum and how you can treat it.

What Is Zenker’s Diverticulum?

Zenker’s diverticulum is a pouch or pocket that can form at the beginning of your digestive tract. It forms above the cricopharyngeal (CP) muscle, which is where your esophagus and pharynx come together. This can happen if the muscle doesn’t work the way it should — for example, by not opening or relaxing easily. The wall of the pharynx, above your esophagus, can then form a little pocket or pouch.

The exact cause is unknown, since Zenker’s diverticulum is quite rare. Less than 0.01% of the population develops this pouch. Doctors think that too much pressure in the esophagus can cause the CP muscle to malfunction. Pressure can also cause the tissue of the esophagus to tear, which can result in a Zenker’s diverticulum.

A pharyngeal diverticulum puts pressure on the area above your digestive tract when you swallow. Because of this, food and liquids have a harder time going down and passing into the esophagus. Materials can then get stuck in the pouch or your throat. This can cause you to regurgitate your food or drinks.

Symptoms

The most common symptom of Zenker’s diverticulum is difficulty swallowing, or dysphagia. Ninety percent of people who have a Zenker’s diverticulum will experience difficulty swallowing both solids and liquids.

Some other common symptoms include:

  • Weight loss
  • Halitosis ( Bad breath) due to food being stuck in the pouch
  • A persistent cough, especially at nighttime
  • Regurgitation of undigested food
  • Hoarse voice or a change in voice
  • Aspiration that can lead to pneumonia
  • Gurgling noises
  • Feeling like something is stuck in your throat

Most people with a pharyngeal diverticulum develop symptoms from their 50s to their 70s.

Since food gets stuck in the pouch, many people may change their diets to include softer foods or things that are easier to swallow. You may also find that you eat less because of difficulty swallowing.

Zenker’s diverticulum can be associated with the following conditions:

Diagnosing and Tests

If your doctor thinks that you might have Zenker’s diverticulum, they will most likely order a test called an esophagram, or barium swallow. A contrast, barium, is used to fill the pouch so that your doctor can see it in pictures. This test helps your doctor better understand what is causing your difficulty when swallowing.

Another test for diagnosing Zenker’s diverticulum is an upper endoscopy. This test is done by an expert so that there is no perforation or tearing of the esophagus. An endoscopy gives your doctor a look at the pouch and how big it is.

The last possibility when it comes to diagnosing Zenker’s diverticulum is esophageal manometry. This is a test that studies the pressure inside of your esophagus.

Treatment and Management

Treatment for Zenker’s depends on the size and severity of the pouch. If your diverticulum is less than one-quarter of an inch in size or if you don’t have bothersome symptoms, you most likely won’t need any surgery.

Mild cases. Mild cases of Zenker’s diverticulum can be managed by changing how and what you eat. If your diverticulum isn’t large enough to require surgery, one thing that you can do is to make sure that you fully chew your food so that it’s easier to swallow. After eating, be sure to drink water to flush down any food that might be stuck in your throat. Cutting out spicy and acidic foods may also help reduce your symptoms.

You should avoid foods with nuts, skins, or seeds since these can get stuck in your throat easily. Stick to soft foods that don’t require much swallowing.

Moderate to severe cases. More serious cases of Zenker’s diverticulum require surgery. Surgery can help with difficulty swallowing, coughing, and aspiration. For large diverticulums, or for those in complicated positions, an open-neck surgery might be the only way to remove the pouch.

There are less invasive methods available. One procedure is a cricopharyngeal myotomy, which is best for smaller Zenker’s diverticulums. In this procedure, your doctor will cut one of the muscles in your esophagus, making it easier to swallow.

Another approach is for larger pouches is a diverticulopexy with cricopharyngeal myotomy. In this procedure, your doctor will attach the diverticulum to the wall of your esophagus. If your doctor thinks it’s best to completely remove the pouch, they will do a procedure called a diverticulectomy and cricopharyngeal myotomy.

While surgery is usually the best course of action for treating Zenker’s diverticulum, it’s important to know that there is a chance that the pouch may return. Around 4% of people who had surgery reported that their pouch came back over time.

Show Sources

SOURCES:

Carle Health: “Pharyngeal (Zenker’s) Diverticulum.”

Memorial Hermann: “Zenker’s Diverticulum.”

Mount Sinai: “Zenker’s Diverticulum.”

Temple Health: “Zenker’s Diverticulum.”

UCLA Health: “Zenker’s Diverticulum.”

UPMC: “Zenker’s Diverticulum.”

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