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An oesophageal pouch is a rare condition also known as a pharyngeal pouch, pharyngoesophageal diverticulum or Zenker's Diverticulum; only about 3 in 100,000 are diagnosed each year. It usually affects men in their 70's or 80's.
It is a pouch-like herniation that occurs in the pharynx, specifically in the posterior hypopharyngeal wall. It is characterized by a sac-like protrusion that develops between the upper esophagus and the lower part of the throat, or pharynx. While it can occur for various reasons, it has been linked to acid reflux in some cases.
Causes of Zenker's Diverticulum
A Zenker's Diverticulum develops when the cricopharyngeal muscle between the throat and esophagus over-tightens, similar to globus, causing the throat above it to pouch out. Overtime, the pouch can enlarge as the muscles below it tighten excessively. Food can catch in this pouch or it can cause an obstruction.
Zenker's Diverticula occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough and aspiration symptoms like extra-oesophageal reflux, and weight loss.
Zenker's Diverticulum is associated with:
Swallowing Disorders: Difficulty swallowing, known as dysphagia, can lead to the development of a diverticulum as the weakened muscles in the throat and upper esophagus struggle to move food or liquid into the stomach.
Chronic Acid Reflux: Acid reflux or gastroesophageal reflux disease (GORD) can irritate and weaken the tissues of the upper esophagus and contribute to the development of a diverticulum over time.
Increased Pressure: Increased pressure in the throat due to conditions like frequent coughing, vomiting, or straining during bowel movements can also be a contributing factor.
Symptoms of Zenker's Diverticulum
The most common symptoms of Zenker's Diverticulum include:
Dysphagia: Difficulty swallowing, often with a sensation of food or liquid getting stuck in the throat.
Regurgitation: The regurgitation of undigested food or foul-smelling substances from the diverticulum.
Coughing and Choking: Due to the accumulation of food particles in the pouch.
Diagnosis of Zenker's Diverticulum
Various methods may be used to diagnose Zenker's Diverticulum including:
Barium Swallow Test: This imaging test involves swallowing a barium solution that can highlight the diverticulum on X-rays.
Endoscopy: A thin, flexible tube with a camera (endoscope) is inserted through the mouth and throat to visualize the diverticulum directly.
Manometry: This test measures the pressure and function of the esophagus and can help identify any swallowing disorders.
Treatment Options
The management of Zenker's Diverticulum typically involves one of the following treatment options:
Dietary and Lifestyle Changes: Adjusting the diet and eating habits to include softer foods and avoiding foods that may aggravate the condition.
Endoscopic Diverticulotomy: A minimally invasive procedure to cut the septum between the diverticulum and the esophagus, allowing the pouch to drain properly.
Surgery: In severe cases or when other treatments are ineffective, surgical removal of the diverticulum may be necessary.
This video presentation from Russells Hall Hospital describes Zenker's Diverticulum and endoscopic diverticulotomy.
Conclusion
While Zenker's Diverticulum is a rare condition, it can be associated with acid reflux and other factors that affect the swallowing process. Early diagnosis and appropriate treatment can alleviate symptoms and improve the quality of life for those affected by this condition.
Page updated 26 September 2024
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