CINCINNATI—Struggling to swallow food or coughing up food while eating is not only embarrassing but it can be a sign of a serious health problem.
“Bad breath, difficulty swallowing, a feeling of food sticking in the throat or unexplained weight loss are all signs of a swallowing disorder,” says UC otolaryngologist Lee Zimmer, MD.
One disorder, called Zenker’s diverticulum, is caused by a pouch that develops in the walls of the lower throat. It usually occurs in people over 50.
“When we swallow, there’s a muscular valve called the upper esophageal sphincter that’s supposed to relax and allow food and liquids to pass. In some people, and we don’t know the exact cause, that muscle doesn’t relax properly,” says Zimmer.
When that happens, the muscle at the top of the esophagus—the tube that connects the pharynx (throat) with the stomach—becomes herniated and a pouch develops.
“We’re not even sure how common this condition is because there are a lot of people who are undiagnosed,” Zimmer says.
The condition is diagnosed through a barium esophagram. For this test, patients swallow a barium liquid—a white, chalky substance—which allows X-ray images to be made of their esophagus.
Zenker’s diverticulum is often categorized as small, medium or large in size. If a patient has a small Zenker’s diverticula and food is not getting caught in the esophagus, he or she can simply be monitored for changes.
For patients who develop a medium or large-sized pouch, surgery is usually recommended.
Zimmer performs the surgery through an endoscopic approach, which has fewer complications than conventional open surgery.
In the endoscopic approach, a scope is placed through the mouth down into the proximal esophagus allowing surgeons to see the esophagus and the pouch.
They then use a special instrument that cuts and staples at the same time to divide the cricopharyngeus (a muscle in the throat that acts as a one-way valve) and the wall between the pouch and the esophagus. This eliminates the pouch by making it part of the upper esophagus.
For patients with a pouch smaller than 2 to 2 ½ centimeters, an endoscopic approach often cannot be done because the stapler is too large and doesn’t fit into the pouch.
“In many cases where the pouch is smaller, surgeons will perform open surgery which has a higher complication rate,” says Zimmer.
“For those patients we still offer an endoscopic approach by using a harmonic scalpel which uses high frequency vibrations to cut and seal the tissue instead of a stapling device.”
Zimmer says there is a success rate of 90 percent for patients who undergo surgery for Zenker’s.
“Zenker’s isn’t a condition that’s just socially embarrassing—it can cause serious health issues. People can experience malnutrition, especially the older population we often see with this condition, and recurrent pneumonia as well as aspiration because food or liquid can enter the unprotected airway,” says Zimmer.
For more information or to schedule an appointment, call (513) 475-8400.
More information on swallowing issues is available at www.netwellness.org, a collaborative health-information Web site run by UC, Case Western Reserve University and Ohio State University and staffed by Ohio physicians, nurses and allied health professionals.