In Zenker’s diverticulum, a pouch or “diverticulum” develops in the upper part of the esophagus, between the mouth and stomach. Food can become stuck in this pouch. This can lead to difficulty swallowing, regurgitation, and choking when eating.

Scientists believe Zenker’s diverticulum (ZD) results from increased tension in the top muscle of the esophagus, called the cricopharyngeus muscle. This can lead to a pouch forming in the weakened area above.

Depending on the severity of ZD symptoms, treatment options may include dietary changes or surgery.

This article describes what ZD is, including its symptoms, causes, diagnosis, and treatment. We also provide a list of questions a person can ask their doctor when discussing surgical options for ZD.

Share on Pinterest
/Getty Images/Stocksy Design by MNT; Photography by PeopleImages/Getty Images/ & Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons

According to the American Academy of Otolaryngology-Head and Neck Surgery, symptoms of ZD include:

According to the United Kingdom’s National Health Service (NHS), a person with ZD may wake up coughing during sleep due to food collecting in the diverticulum. This may lead to frequent regurgitation.

A person who experiences frequent regurgitation is at increased risk of developing aspiration pneumonia. This is where a person accidentally inhales food, liquids, or bodily fluids, such as saliva.

Researchers do not fully understand the cause of ZD. According to a 2022 review, most researchers believe that the condition relates to an atypical structure and function of a neck muscle called the cricopharyngeus. Atypical pressure during swallowing can cause the muscle to split, resulting in the formation of a diverticulum.

Older age is also a risk factor for ZD.

Doctors may use certain tests to find out whether a person has ZD and to rule out other conditions with similar symptoms. These conditions will include:

Below are two tests a doctor may use to diagnose ZD. Both involve investigating the upper digestive tract, which consists of the following structures:

  • the back of the mouth
  • the throat
  • the esophagus
  • the stomach
  • the duodenum, the upper section of the small intestine

Barium swallow with videofluoroscopy

A barium swallow with videofluoroscopy involves swallowing a substance called barium to help the upper digestive tract show up more clearly on X-ray images. The test allows doctors to determine the size, function, and condition of the different parts of the upper digestive system.

Upper endoscopy

An upper endoscopy involves inserting an endoscope — a long, thin, and flexible tube — into a person’s upper digestive tract. The tube has a camera at the end and allows the doctor to visually examine the different parts of the upper digestive system.

This test is useful for ruling out other causes of symptoms and identifying signs of ZD, such as food buildup in the diverticulum or scar tissue around the diverticulum.

People who do not experience symptoms of ZD do not require treatment for the condition. For those with symptoms, treatment options may vary according to the severity of the diverticulum and its associated symptoms.

Some treatment options include the below.

Botox injections

If a person experiences difficulty swallowing, their doctor may recommend injections of botulinum toxin, which people know as Botox, to improve their swallowing function.


Doctors classify ZD in terms of the following sizes:

Surgery may be necessary if a ZD is large and a person is experiencing symptoms.

However, a doctor will weigh the potential benefits and risks of surgery on a case-by-case basis.

A surgeon may perform one of two types of surgery for ZD: open or endoscopic surgery.

Open surgery

If a ZD is large or the person has a shorter neck or obesity, a doctor will usually recommend open surgery.

During open surgery, a surgeon makes a small cut in the neck to remove the diverticulum or tack it upside down to stop it from collecting food. The surgeon then cuts the cricopharyngeus muscle that sits below the ZD to prevent the diverticulum from reforming.

Endoscopic surgery

If a ZD is under 2 cm, a doctor may do endoscopic surgery if surgery is necessary.

Endoscopic surgery is less invasive than open surgery. It involves inserting an endoscope into a person’s mouth and then threading tiny surgical instruments through the endoscope to carry out the surgery.

During this procedure, a surgeon uses a stapler or a laser to separate the wall between the esophagus and the ZD. This opens up a passageway for food and liquid to flow directly into the esophagus without getting stuck.

Using a laser may result in faster symptom relief and a reduced risk of the diverticulum recurring compared with using a stapler.

Dietary changes

People with mild symptoms of ZD may find symptom relief by making changes to their diet and eating habits.

Examples include:

  • avoiding foods that are high in fat are spicy or acidic
  • chewing food well before swallowing
  • drinking plenty of water after eating

People who receive open surgery tend to stay in the hospital for a few days after the operation. Conversely, those who receive endoscopic surgery will likely have a shorter hospital stay.

During recovery, some people experience symptoms such as:

Both types of surgery have links to certain risks, including:

  • esophageal stenosis, an atypical tightening of the esophagus
  • a perforated esophagus
  • recurrent laryngeal nerve injury
  • sores or ulcers
  • mediastinitis, which refers to inflammation of the area between the lungs

However, endoscopic surgery is generally a safe and effective procedure that a person can undergo more than once if symptoms return.

An individual should discuss the potential benefits and risks with their doctor before electing to undergo surgery.

It is important that a person feels fully informed about their diagnosis and treatment. Some questions to ask a doctor include:

  • Do I need surgery?
  • What are the risks of surgery?
  • Will I have pain after surgery?
  • What can I eat after surgery?
  • Can I have surgery if I have a pacemaker?
  • What should I do before, during, and after surgery if I am on blood thinners?
  • What happens if my symptoms come back after surgery?

Zenker’s diverticulum (ZD) is a rare condition where a pouch or “diverticulum” forms in the upper part of the esophagus. The diverticulum can trap food, liquids, and saliva. This can result in a range of symptoms, including swallowing difficulties or food regurgitation. It may even cause aspiration pneumonia, which is when a person breathes food or liquid into the airways or lungs.

Most medical professionals believe that ZD occurs due to an issue with the cricopharyngeus muscle in the neck. Individuals with moderate or severe ZD may require surgery to correct the diverticulum. Those with mild ZD symptoms may benefit from certain changes to their diet and eating habits.

Surgery for ZD is generally safe and effective, though there may be certain risks. A person should discuss the potential benefits and risks with their doctor before deciding to undergo surgery.