Jeffrey Landis [not his real name], 74, had been complaining of swallowing problems for a couple of months. His wife urged him to go to the doctor, but he delayed a visit, thinking that his symptoms would resolve. But one day, during his afternoon duties as a reading tutor, he regurgitated a piece of sandwich he had eaten at lunch-and it was undigested. In addition to his embarrassment, Mr. Landis was alarmed, and called up his otolaryngologist’s office for a visit the next day.
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April 2009Otolaryngologists-head and neck surgeons would most likely identify Mr. Landis’s symptoms as suspicious for esophageal diverticulum. How they would go about establishing a definitive diagnosis and planning treatment was a topic ENT Today explored recently with head and neck surgeons who see patients with esophageal diverticula in their practices.
Prevalence and Presentation
Zenker’s diverticulum (ZD) is the most common type of esophageal diverticula, and develops in the triangular space between the inferior pharyngeal constrictor muscle and the cricopharyngeus muscle. Although its etiology has not been definitively established, ZD appears to be caused by the discoordination between the two muscle groups. Increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter can cause the hypopharyngeal mucosa to pouch out and prolapse through the triangular space. Food gets diverted into and trapped inside the diverticular pouch instead of passing through the hypopharynx into the esophagus.1,2 (There are other inherent areas of weakness along the esophageal wall, where lateral or Killian-Jamieson diverticula can also occur.)