Swallowing difficulties can occur at any age, but are most common among the elderly population due to the aging process and a natural weakening of the muscles of the esophagus which must propel the food toward the stomach. One cause of dysphagia in older patients is a Zenker's diverticulum.
A Zenker's diverticulum is a pouch that forms at the end of the throat and the beginning of the esophagus (the swallowing tube). Over a lifetime of swallowing, when there is excessive pressure within the lower portion of the pharynx (the back wall of the throat), the weakest portion of the pharyngeal wall balloons out. Over time, a diverticulum forms which can gradually increase in size and become several centimeters in diameter. Thus, this is a condition almost always seen in the elderly (patients over 60).
The most common symptoms of a Zenker's diverticulum are difficulty swallowing food, choking, collection of mucus in the throat, hoarseness and/or bad breath, all of which can be distressing. When the Zenker's diverticulum is small, most patients usually experience no symptoms, but as it increases in size, over time, the symptoms listed above begin to develop. Food may be regurgitated back into the throat or mouth in a relatively undigested form, several minutes to hours after eating.
The diagnosis of a Zenker's diverticulum is made using a simple radiographic test called a barium swallow. Contrast material called barium is swallowed and the diverticulum is able to be visualized using real-time x-ray called fluoroscopy.
Surgical intervention is the only treatment available that will effectively cure patients with a Zenker's diverticulum, permanently relieving symptoms and improving the quality of life. There are no medications available that will treat the condition and if left untreated, patients with a Zenker's diverticulum will continue to have difficulty swallowing, with possible associated risks of weight loss, malnutrition, and pneumonia caused by food entering the lungs from the pouch. Although uncommon, these can be life threatening.
Treatment would include performing an endoscopic excision of a Zenker's diverticulum which is an approach done through the mouth to correct the Zenker's diverticulum. This newer technique is less invasive than the traditional approach of removing a Zenker's diverticulum through an incision in the neck. This allows for a quicker recovery and return to a normal diet in a shorter period of time. Although technically difficult, this procedure is a safer approach for the patient when it can be performed successfully.
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