Symptoms of Zenker's Diverticulum
The primary symptoms of Zenker's diverticulum include dysphagia (difficulty swallowing), regurgitation of undigested food, halitosis (bad breath), and chronic aspiration, with dysphagia being the most common presenting complaint. 1, 2
Common Clinical Manifestations
Primary Symptoms
- Dysphagia: Most common presenting symptom, typically affecting elderly patients 2
- Regurgitation: Undigested food returns to the mouth, often hours after eating 3
- Halitosis: Bad breath due to food trapped in the diverticulum 1
- Chronic cough: Particularly at night or when lying down 4
Secondary Symptoms
- Globus sensation: Feeling of a lump in the throat 4
- Weight loss: Due to difficulty with food intake 4
- Aspiration: Can lead to pneumonia, a serious complication 2
- Choking episodes: Particularly during sleep 3
Diagnostic Considerations
Zenker's diverticulum is often misdiagnosed initially because physical examination may appear normal 4. The condition typically affects elderly patients, with a higher prevalence in males 1.
Diagnostic Approach
- Barium swallow study: The gold standard for confirming diagnosis 1
- Videofluoroscopy: Highly effective in visualizing the diverticulum during swallowing 2
- Endoscopy: May be used but carries risk of perforation if the diverticulum is not identified beforehand 5
Clinical Progression
Symptoms typically worsen over time as the diverticulum enlarges. The natural progression includes:
- Initial mild dysphagia
- Progressive difficulty swallowing
- Development of regurgitation
- Potential aspiration and respiratory complications
Complications
- Aspiration pneumonia: Most serious complication 2
- Malnutrition: Due to progressive dysphagia 5
- Dehydration: Secondary to difficulty swallowing liquids
- Social isolation: Due to embarrassing symptoms during meals
Pathophysiological Basis
Zenker's diverticulum occurs at the dorsal pharyngoesophageal junction through Killian's dehiscence (the weak area between the inferior constrictor muscle's oblique fibers and transverse fibers of cricopharyngeal muscle). It is caused by increased intrabolus pressure, often related to cricopharyngeal muscle dysfunction 1.
Important Clinical Pearls
- Symptoms are often attributed to other conditions, leading to delayed diagnosis
- Physical examination is typically normal despite significant symptoms
- The condition is most common in patients over 70 years of age
- Symptoms may be exacerbated by certain positions, particularly lying down
- Food particles may be regurgitated hours or even days after consumption
Understanding these symptoms is crucial for early diagnosis and appropriate management of Zenker's diverticulum, as timely intervention can prevent serious complications such as aspiration pneumonia and malnutrition.