[Pathogenesis and treatment of Zencker's diverticulum]

The aims of this study were: 1) To measure pharyngeal and upper oesophageal function manometrically at the same time as recording video images of the patient swallowing barium, in normal controls and patients with Zenker's diverticulum, and, 2) In those patients who progressed to surgery to biopsy the cricopharyngeus and compare the findings with biopsies from normal controls. Subjects were seated in front of a fluoroscope and video images of a barium swallow were synchronised with a multichannel recording catheter which contained 3 perfused side holes 1 cm apart (situated in the pharynx) and a 4 cm long perfused sleeve pressure sensor (positioned across the upper oesophageal sphincter). The coordination of the upper sphincter with swallowing, its relaxation, the pressures generated in the distal pharynx and the maximum luminal area of the open upper sphincter, were calculated for different volumes of barium swallowed in 11 patients with a Zenker's diverticulum (mean age 71 years, range 50-99) and 9 normal controls (mean age 65 years, range 55-86). Seven patients progressed to cricopharyngeal myotomy and their biopsies were compared with biopsies from 9 normal controls. In patients with Zenker's diverticulum intrapharyngeal pressures during barium swallows were significantly greater (p less than .05) and maximal luminal areas of the open sphincter were significantly less (p less than .05) than in control patients. In patients having a cricopharyngeal myotomy, intrapharyngeal pressures and maximum luminal areas returned to normal after surgery. The cricopharyngeus muscle of patients with a Zenker's diverticulum showed significantly increased fibrosis compared with normal controls.(ABSTRACT TRUNCATED AT 250 WORDS)