Zenkers or Pharyngeal Pouch

Throat | Gastroenterology | Zenkers or Pharyngeal Pouch (Disease)


Description

Esophageal diverticula are circumscribed dilatations of the esophagus. When all layers are interested a true verticulum develops. When only the mucosa and submucosa are interested a pseudodiverticul develops. Zenker diverticula is located on the back of the pharyngo-esophageal junction and is characterized by the mucosal protrusion between the muscle fibers and the lower pharynx. It frequently accompanies the gastro-oesophageal reflux disease and esophageal motility disorders.

Pouches in the neck usually cause bad breath (halitosis) and the regurgitation of swallowed food and saliva. Some patients with Zenkers diverticula can push on their neck and make old food appear in their mouths. Pouches near the stomach may cause swallowing problems, conditions known as achalasia or dysphagia. Mid-esophageal pouches usually cause no symptoms. In the most serious cases, a person may be unable to swallow because the esophagus is obstructed, or the esphagus may rupture, spilling its contents into the chest or neck.

Causes and Risk factors

Esophageal diverticula can be congenital or earned. Zenker diverticula occurs around age 50 years. To propel food out or into the stomach the esophagus generates internal pressure. Under certain circumstances, that pressure can herniate the esophageal lining through a weakness in the wall, creating a pouch. A traction diverticulum can develop from a scar that pulls the esophagus out of shape. Food and saliva can collect in all of these pouches.

Diagnosis and Treatment

Difficulty swallowing, bad breath, or food reappearing in the back of the mouth may signal the presence of this condition. Sometimes the patient may experience pain in the chest resembling a heart attack. A series of X-rays taken while swallowing a contrast agent usually demonstrates the diverticulum clearly. An esophagoscopy may also be needed to gather more detail. Manometry, measuring pressures inside the esophagus using a balloon that is passed down it, may help determine the cause of the diverticula.

Treatment for this condition is primarily aimed at alleviating symptoms. Physicians direct the patient to eat a bland diet, to chew his or her food thoroughly, and to drink water after eating to clean out the pouches. If the condition is severe, several types of surgery are available to remove the pouches and repair the defects. If a pouch is due to a stenosis (narrowing) in the esophagus it may be possible to relieve it by passing a dilator through it, a process called bougeinage. ...