Zenker Diverticulum - Etiology, Symptoms, and Treatment
A Zenker’s diverticulum often develops in the hypopharynx between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle. This typically corresponds to the level of cervical vertebrae 5 and 6 and is referred to as Killian triangle (Bizzotto et al., 2013; Nesheiwat & Antunes, 2023). Zenker’s diverticulum only involves the mucosa and submucosal layers and does not involve the muscular layer, hence making it a false diverticulum (Nesheiwat & Antunes, 2023).
The etiology of Zenker’s diverticulum is not completely understood. It is hypothesized that Zenker’s diverticulum is the result of abnormal structure and physiology of the cricopharyngeus muscle, with the thought that abnormal pressure during swallowing results in splitting of the muscle, in turn causing a Zenker diverticulum (Nesheiwat & Antunes, 2023).
Initially, Zenker’s diverticulum may not result in any symptoms, however, as they increase in size they may result in gradually increasing dysphagia, as well as globus, food regurgitation, voice changes, halitosis, aspiration, weight loss, coughing, and more (Achkar, 1998; Law et al., 2014; Nehring & Krasnodębski, 2013). The incidence of Zenker diverticulum is rare, however, development is more typical after the age of 40 and is more frequent for men than women (Hoffmann et al., 2015; Nesheiwat & Antunes, 2023; Uoti et al., 2022).
Barium swallow with videofluoroscopy can provide more information regarding the size, location, character of the mucosal lining, and diagnoses of the condition, while upper endoscopy including both flexible and rigid assessments are also frequently used (Nesheiwat & Antunes, 2023). The therapeutic approach utilized to address a Zenker diverticulum is dependent on the diverticulum size and clinical presentation, however, treatment options may involve surgery, or for conservative management, calcium channel antagonists and nitrates or botulinum toxin (Bizzotto et al., 2013; Nehring & Krasnodębski, 2013; Nesheiwat & Antunes, 2023; Smith et al., 2002).
To learn more about Zenker’s diverticulum, check out the references cited in this review.
