Patient education: Zenker's diverticulum (The Basics)

What is Zenker's diverticulum? — This is a small pouch that forms in the back of the throat (figure 1). It happens when there is a weak area in the wall of the throat where the esophagus begins. (The esophagus is the tube food travels through on the way to the stomach.)

Zenker's diverticulum most often affects older adults. It is more common in males than in females.

What are the symptoms of Zenker's diverticulum? — A small Zenker's diverticulum might not cause any symptoms. But symptoms can happen if the pouch is big enough for food or pills to get stuck in it. Symptoms can include:

●Trouble swallowing or pain when swallowing

●Feeling like food is stuck in your throat

●Bad breath

●A gurgling sound in the throat

●A lump in the neck

●Swallowed food coming back up ("regurgitation")

In some people, Zenker's diverticulum can lead to other problems. For example, bits of food can get into the lungs, which can cause infection. If pills get stuck in the pouch, it can injure the inside of the throat.

Is there a test for Zenker's diverticulum? — Yes. The doctor or nurse will do an exam and learn about your symptoms. They will also order tests. These can include:

●Barium swallow – Your doctor will give you a drink called "barium." Then, they take an X-ray as the barium moves down your esophagus. This can show if there is a pouch in the back of your throat.

●Upper endoscopy – For this procedure, your doctor will put a thin tube with a camera on the end into your mouth and down into your esophagus and stomach (figure 2). This can sometimes show if you have a Zenker's diverticulum. It also lets the doctor check for other things that could be causing your symptoms.

●Ultrasound – This test uses sound waves to create pictures of the inside of your throat and esophagus. It might be done instead of a barium swallow if you have trouble swallowing.

How is Zenker's diverticulum treated? — If you have a small Zenker's diverticulum that is not causing symptoms, you probably will not need treatment.

If you have a large Zenker's diverticulum or symptoms that bother you, your doctor will probably recommend surgery. The goal of surgery is to fix the pouch so food cannot get stuck in it. This can be done in 2 ways:

●Open surgery – This involves making a cut in your neck to do the surgery. The doctor will use special tools to make a cut in the muscle at the top of your esophagus. This removes the pouch or changes its shape so food will no longer get stuck.

●Endoscopic surgery – For this type of surgery, the doctor does not cut into your skin. Instead, they insert the tools through your mouth and into your throat. Then, they fix the pouch from the inside.

If your doctor recommends surgery, they will talk to you about your options.

Is there anything I can do on my own? — If you have only mild or occasional symptoms, it might help to:

●Eat slowly – This helps prevent food from building up in the pouch in your throat.

●Eat pureed foods with a soft texture – Some people choose to eat pureed foods or a liquid diet that is easier to swallow and causes less pain. If you want to do this, it can help to work with a dietitian (expert on food and eating). They can help you choose foods that taste good and give your body the nutrients and energy it needs.

●Brush your teeth before and after eating – Brushing regularly lowers the amount of bacteria in your mouth. Then, if bits of food get into your lungs, they are less likely to cause a bacterial infection.

If your symptoms get worse, talk to your doctor or nurse.

More on this topic

Patient education: Dysphagia (The Basics)
Patient education: Upper endoscopy (The Basics)
Patient education: Pureed diet (The Basics)