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Friday, May 24, 2013
Struggling to swallow food or coughing up food while eating is not only embarrassing but it can be a sign of a serious health problem.
One disorder, called Zenker's diverticulum, is caused by a pouch that develops in the walls of the lower throat. It usually occurs in people over 50.
When we swallow, there's a muscular valve called the upper esophageal sphincter that's supposed to relax and allow food and liquids to pass. In some people, and we don’t know the exact cause, that muscle doesn’t relax properly.
When that happens, the muscle at the top of the esophagus, which is the tube that connects the pharynx (throat) with the stomach, becomes herniated and a pouch develops.
We're not even sure how common this condition is because there are a lot of people who are undiagnosed.
The condition is diagnosed through a barium esophagram. For this test, patients swallow a barium liquid (a white, chalky substance) which allows X-ray images to be made of their esophagus.
Zenker's diverticulum is often categorized as small, medium or large in size. If a patient has a small Zenker's diverticula and food is not getting caught in the esophagus, he or she can simply be monitored for changes.
For patients who develop a medium or large-sized pouch, surgery is usually recommended.
The surgery is performed through an endoscopic approach, which has fewer complications than conventional open surgery.
In the endoscopic approach, a scope is placed through the mouth down into the proximal esophagus allowing surgeons to see the esophagus and the pouch.
They then use a special instrument that cuts and staples at the same time to divide the cricopharyngeus (a muscle in the throat that acts as a one-way valve) and the wall between the pouch and the esophagus. This eliminates the pouch by making it part of the upper esophagus.
For patients with a pouch smaller than 2 to 2 ½ centimeters, an endoscopic approach often cannot be done because the stapler is too large and doesn’t fit into the pouch.
In many cases where the pouch is smaller, surgeons will perform open surgery which has a higher complication rate.
For those patients we still offer an endoscopic approach by using a harmonic scalpel which uses high frequency vibrations to cut and seal the tissue instead of a stapling device.
There is a success rate of 90 percent for patients who undergo surgery for Zenker's.
Zenker's isn't a condition that's just socially embarrassing. It can cause serious health issues. People can experience malnutrition, especially the older population we often see with this condition, and recurrent pneumonia as well as aspiration because food or liquid can enter the unprotected airway.
This article originally appeared in UC Health Line (3/13/08), a service of the University of Cincinnati Academic Health Center Public Relations Department and was adapted for use on NetWellness with permission, 2006.
Last Reviewed: Mar 24, 2008
Lee Zimmer, MD
Assistant Professor or Otolaryngology, Director of Endoscopic Cranial Base Center
College of Medicine
University of Cincinnati