Zenker’s Diverticulum

Zenker’s Diverticulum

A Zenker diverticulum is a bulge in the pharynx. It can cause difficulty swallowing.

What is a Zenker diverticulum?

The Zenker diverticulum is counted among the esophageal diverticula, although it is located in the throat (hypopharynx) and not directly in the esophagus (esophagus). In addition, the Zenker diverticulum is considered a pseudodiverticulum (false diverticulum). Due to its location, it is also counted among the boundary diverticula. For meanings of pt, please visit polyhobbies.com.

The Zenker diverticulum was first described in 1764 by Abraham Ludlow. The German physician Friedrich Albert von Zenker (1825-1898) acted as the namesake of the sacking. Older men are particularly affected by a Zenker diverticulum.

Causes

Zenker’s diverticulum is caused by a dysfunction in the upper esophageal sphincter. If the muscle opens and closes correctly, the chyme can easily pass from the throat into the esophagus. However, when a Zenker’s diverticulum is present, the muscle closes prematurely during the swallowing process, which can cause pressure to build up in the lower pharynx when larger pieces of food are involved.

In addition, there is a natural weak point in the throat muscles at the transition to the muscles of the esophagus. The reason for this is the different course of the muscle fibers. This creates a muscle-weak triangle, which doctors call the Kilian muscle gap. If greater pressure arises during the swallowing process, the mucous membrane is pressed through this gap, which causes it to bulge outwards.

As the Zenker diverticulum continues to enlarge, the esophagus is pushed forward, which in turn puts pressure on the surrounding tissue. In most cases, Zenker’s diverticulum is permanent. In some sufferers, further diverticula form within the esophagus.

Symptoms, Ailments & Signs

Medicine divides the Zenker’s diverticulum into four different degrees of severity from stage 1 to 4.

  • In stage 1, a thorn-shaped niche forms that reaches a length of two to three millimeters. This niche is not always recognizable.
  • In stage 2, the niche is seven to eight centimeters long.
  • In stage 3, it can reach a length of more than four inches.
  • Stage 4 is when the patient’s esophagus is compressed by a sac. As a result, the affected person suffers from discomfort.

The nature of the symptoms depends on the extent of the Zenker’s diverticulum. There is usually no pain with small protrusions, although swallowing difficulties can occur. In the case of larger protrusions, food residue can be deposited. If these start to rot, this will result in unpleasant bad breath.

If the patient is asleep, food particles can flow back. There is a risk if these penetrate into the respiratory system because they sometimes trigger pneumonia (aspiration pneumonia). In some people, a fistula forms inside the trachea. The formation of a hole in the wall of Zenker’s diverticulum is also within the realm of possibility.

Symptoms of Zenker’s diverticula begin insidiously and increase over time. Initially, the patients complain of a sore throat, often have to clear their throat and feel a foreign body. As the disease progresses, difficulty swallowing occurs. When drinking, a gurgling noise can often be heard. In some cases, Zenker’s diverticulum can be felt on the left side of the neck.

Diagnosis & course of disease

If there is a suspicion of a Zenker diverticulum, the doctor first looks at the medical history (anamnesis) of the patient. In this way, complaints and age can give the physician initial indications of the cause. In order to clearly diagnose a Zenker’s diverticulum, however, a special x-ray and pap-swallow examination is required.

The patient has to swallow a water-soluble contrast agent, which is distinguished from the neighboring tissue on the X-ray by a white coloration. If there is a diverticulum, this is filled with the contrast agent, which the doctor can see on the X-ray as a white bulge. Dynamic video fluoroscopy is used to diagnose movement disorders.

In the course of this, the swallowing process is recorded on video. It can also be useful to measure the pressure in the esophagus ( manometry ) using a catheter. While the doctor slowly pulls back the tube and the patient swallows when prompted, he takes the measurement. If the Zenker’s diverticulum is treated accordingly, it usually takes a positive course. It can usually be completely eliminated with a surgical procedure. The success rate is 95 percent. Only rarely does a Zenker diverticulum develop again later.

complications

Those affected primarily suffer from severe difficulty swallowing with this disease. Difficulties in taking in food and liquids arise, so that patients can also suffer from deficiency symptoms or from dehydration. Sometimes the child’s development is significantly restricted and reduced due to the symptoms, so that it may be disturbed. In some cases, these continue into adulthood.

An unpleasant bad breath can also occur with this disease and thus have a very negative effect on social contacts. Most of those affected often suffer from inflammation of the lungs or infections of the gums. A sore throat also occurs.

As a rule, this disease can be treated relatively easily and quickly. There are no special complications or any other serious course. However, those affected are dependent on a gentle and, above all, light diet after the treatment. There are no other restrictions in everyday use. The life expectancy of those affected also remains unchanged by the disease.

When should you go to the doctor?

If the offspring reports swallowing difficulties or if there are changes in the act of swallowing in adulthood, there is an increased duty of care. If the symptoms last less for several days or weeks or if they show increasing intensity, there is a need for action. A doctor’s visit is necessary as these are unusual signs that need to be investigated. If food intake can no longer take place without symptoms or if there are problems with drinking, it is advisable to clarify the symptoms.

Loss of appetite, changes in weight or disturbances in eating habits are other signs that should be investigated. If the vocalization changes, if the voice becomes hoarse or if the affected person has a scratchy throat, a doctor should be consulted. Inflammation of the gums, irregular breathing and pneumonia indicate the presence of Zenker’s diverticulum. The observations should be discussed with a doctor so that further medical tests can be carried out.

If symptoms of deficiency, a decrease in performance, fatigue or exhaustion appear due to the impairment of food intake, the person concerned needs medical help. A doctor’s visit is advisable so that a treatment plan can be drawn up and measures taken to alleviate the symptoms. If you feel dry inside, consult a doctor immediately. There is a risk of dehydration and thus a life-threatening development.

Treatment & Therapy

Surgery is required to successfully treat Zenker’s diverticulum, during which the sac is completely removed. Minimally invasive transoral diverticulopexy is often used. During this reflection, the diverticulum is removed with a tubular endoscope.

A surgical opening of the esophagus is not necessary because the endoscope can be pushed through the mouth to the affected area. In the classic open operation (myotomy), on the other hand, greater effort is required. On the other hand, conservative therapy measures are not considered to be helpful.

If an operation cannot be performed due to the general condition of the patient, the symptoms can be improved by changing the diet. Eating porridge and light whole foods is recommended. It is also advisable not to consume acidic foods or drinks.

Prevention

It is not possible to prevent a Zenker diverticulum. In order to protect the esophagus, a lot of fruit and vegetables and smaller portions should be eaten. A low-fat diet is also advisable.

Aftercare

As part of aftercare, it seems important to ensure that the portions of food consumed by those affected are not too large. Otherwise, it is not uncommon for problems with the act of swallowing to occur, which worsen the overall situation. It is advisable to continuously and specifically train the muscles in the mouth and throat area several times a day, even when you are not eating.

In this way, their functional activity can be supported and their general well-being improved. However, you should avoid eating while lying down. Sitting as upright or straight as possible supports the natural swallowing mechanism and thus helps to reduce complications.

A forward-leaning posture can also lead to disorders. At the first irregularities during feeding, the process should be slowed down or stopped. Eating should be done cautiously. The symptoms increase with excitement or restlessness. Despite all adverse circumstances, it is important to check every day whether the food and drink intake is sufficient.

You can do that yourself

When eating food, make sure that it is not too big. The food should be sufficiently broken up into small pieces before it is put into the mouth. In the mouth, it must then be ground up with the teeth as best as possible before it is then transported further into the gullet. Larger pieces of food cause problems when swallowing. These can make a significant contribution to worsening the overall situation.

The muscles in the mouth and throat can also be regularly and specifically trained several times a day outside of food intake. This supports their functional activity and general well-being can be improved. Eating should never be done while lying down. Sitting upright or straight helps the natural mechanism of swallowing and can reduce the likelihood of complications. A posture that is hunched forward can also lead to obstruction and disruption.

As soon as irregularities occur during feeding, the process should be interrupted or slowed down. You should take your time when eating and don’t eat food in a hectic state. When you are restless or excited, the symptoms increase. Despite all adversities, it is necessary to check daily whether sufficient food and drink intake has taken place.

Zenker’s Diverticulum