Zenker’s Diverticulum – Symptoms and Causes

Overview

Zenker’s diverticulum is a pouch that forms in the throat where the pharynx meets the esophagus. This condition most often affects older adults, particularly those over 60.

The pouch develops in a natural area of weakness in the throat wall and can vary in size. In some cases, it remains small and unnoticed for years. As it enlarges, however, it can interfere with normal swallowing and potentially affect quality of life.

Early recognition and medical evaluation are important to help guide appropriate management and prevent complications.

Symptoms

Zenker’s diverticulum typically develops slowly over time. Many people with this condition experience trouble swallowing (dysphagia). Food may feel stuck in the throat during meals.

Bad breath (halitosis) often occurs because food particles get trapped in the pouch. Some patients report regurgitation of undigested food hours after eating. This happens when the pouch fills up and its contents flow back into the throat.

Coughing, especially after eating, is another common symptom. Some people notice gurgling noises in the neck during swallowing. Weight loss may occur in severe cases when eating becomes difficult or painful.

Other symptoms include:

• Frequent throat clearing
• Hoarseness
• Feeling of a lump in the throat
• Aspiration (inhaling food into the lungs)
• Choking episodes
• Neck pain or discomfort

Sometimes, patients delay seeking treatment, attributing their symptoms to normal aging.

Causes

Zenker’s diverticulum occurs when the muscle between the lower throat and esophagus (called the cricopharyngeus muscle) doesn’t relax properly during swallowing.

This creates increased pressure in the throat, which gradually pushes the lining of the throat through a weak spot in the muscle.

Age plays a significant role in developing this condition. Most people diagnosed with Zenker’s diverticulum are older adults, typically over 60 years old. The muscle and tissue weakness that comes with aging contributes to this problem.

Several factors may increase the risk of developing Zenker’s diverticulum:

• Chronic inflammation of the throat and esophagus
• Gastroesophageal reflux disease (GERD), which causes stomach acid to back up into the esophagus
• Hiatal hernia, where part of the stomach pushes through the diaphragm
• Neuromuscular disorders affecting throat muscles

Research suggests that some people may have a genetic predisposition to developing this condition. Family history might increase risk, though this connection needs more study.

Risk Factors

Several factors may increase a person’s chances of developing Zenker’s diverticulum. Age plays a significant role, as this condition most commonly affects older adults, typically those over 60 years old.

Men face a higher risk than women, with research showing they develop this condition about twice as often.

People with certain muscle disorders affecting the upper esophagus might be more susceptible. Long-term acid reflux or GERD (gastroesophageal reflux disease) may contribute by causing inflammation and increased pressure in the throat area.

Anatomical factors can also influence risk. Some individuals have naturally occurring weaknesses in the muscle wall where the pharynx meets the esophagus. This area, called Killian’s triangle, is where the pouch typically forms.

Other potential risk factors include:

• History of swallowing disorders
• Certain neurological conditions
• Previous neck injuries or trauma
• Family history of digestive tract disorders

Complications

Zenker’s diverticulum can lead to several complications if left untreated. Food and saliva may collect in the pouch, which can cause bad breath and recurring respiratory infections. Some patients experience regurgitation of undigested food hours after eating.

Weight loss and malnutrition are common complications as eating becomes difficult and uncomfortable. Many people with this condition reduce their food intake because of the discomfort, leading to nutritional deficits over time.

Aspiration pneumonia represents a serious complication. This occurs when food particles or liquid from the diverticulum enter the lungs, causing infection. The risk increases with the size of the pouch.

In rare cases, the diverticulum may become infected or develop ulcerations. Some studies suggest that long-standing Zenker’s diverticulum slightly increases the risk of developing cancer in the pouch, though this is uncommon.

Physical complications can include:

• Chronic cough
• Hoarseness
• Voice changes
• Neck swelling or pain
• Difficulty swallowing medications

The psychological impact shouldn’t be overlooked. Many patients report anxiety around eating in public or social settings, which can lead to isolation and decreased quality of life.