The pathophysiological basis of Zenker's diverticulum

Disorders of the pharyngoesophageal phase of swallowing, including Zenker's diverticulum, result from alterations of the neuromuscular events involved in chewing, initiation of swallowing, and propulsion of the material from the oropharynx into the cervical esophagus. Although a number of mechanisms have been postulated to explain the genesis of Zenker's divertcula, including sphincter incoordination, swallowing against a closed UES, failed UES relaxation, and a hypertensive spastic upper sphincter, recent evidence suggests that the pathophysiology of Zenker's diverticula involves altered compliance of the cricopharyngeal segment. Manometric relaxation may occur in the absence of anatomic opening. Incoordination is uncommon. Altered compliance is detectable with specialized cricopharyngeal manometric recording as impaired sphincter opening or a raised intrabolus pressure. Both return to normal following diverticulectomy and cricopharyngeal myotomy.