Cricopharyngeal Spasm and Zenkers Diverticulum
Dysphagia (pronounced dis-FAY-juh) means trouble with swallowing. Swallowing is a very complex process involving three phases—oral, pharyngeal, and esophageal.
Initially, food placed in the mouth is chewed and mixed with saliva in preparation for swallowing. Then the mixture (called a bolus) is pushed to the back of the throat by the anterior tongue. This is the portion of the tongue visible when you look in your mouth. This first phase is the oral phase of swallowing.
Next, the back of the tongue, along with other throat (pharyngeal) muscles, pushes the food and/or liquid downwards, towards the esophagus. This is the pharyngeal phase of swallowing.
The upper esophageal sphincter (the cricopharyngeal muscle) briefly relaxes, allowing the passage of the food bolus into the esophagus. The cricopharyngeus muscle then immediately closes again to prevent regurgitation of food back up into the throat.
Once the food bolus enters the esophagus, the rhythmic and coordinated muscle contractions of the esophagus (peristalsis) propel it towards the stomach. This is the esophageal phase of swallowing.
Lastly, the lower esophageal sphincter, which is at the junction of the esophagus and stomach, temporarily relaxes, allowing the food bolus to enter the stomach.
Persistent spasm of the cricopharyngeal muscle prevents food and liquid from easily entering the esophagus. This causes trouble swallowing, choking, or food getting stuck in the throat. Patients often have to alter the quantity and consistency of food they eat, and frequently give a history of having to “wash down” every bite with some liquid. These symptoms can present gradually or with sudden onset.
X-ray with arrow pointing to Zenker's diverticulum
If cricopharyngeal spasm is left untreated for many years, it can lead to an out-pouching of the throat wall (the pharynx), into a sac. This sac, called a Zenker’s diverticulum, can accumulate previously swallowed food and liquid. This will further aggravate the swallowing problem, causing coughing, choking, and regurgitation of foul material that was swallowed days or weeks earlier.
Dysphagia that is the result of persistent cricopharyngeal spasm and/or a Zenker’s diverticulum is particularly amenable to surgical correction. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the Zenker’s diverticulum. There are several highly successful options, and some patients may even be candidates for minimally invasive endoscopic repair. Prior to making a formal treatment plan, the various options will be discussed with you.