Esophageal Diverticula with Case

00:01 Let's move on to our next case.

00:03 We have 55-year-old man who presents to clinic complaining of several months of difficulty swallowing.

00:09 He notes mild chest discomfort immediately after swallowing.

00:12 He sometimes regurgitates undigested food and complains of bad breath.

00:17 He has lost 3 kg unintentionally.

00:19 He does not smoke or drink alcohol, and denies any symptoms of acid reflux.

00:24 On exam, vitals are normal. His abdominal exam and oropharyngeal exam are both unremarkable.

00:32 What is the best diagnostic step to confirm the diagnosis here? So let's go through some key features.

00:38 He has chronic dysphagia, he has regurgitation and halitosis or bad breath, and a pretty normal physical exam.

00:49 So let's talk a bit about esophageal diverticula.

00:52 Esophageal diverticula can form due to muscular weakness in the esophageal wall that usually results from an underlying motility disorder.

01:00 So the most common type here is called a Zenker diverticulum.

01:05 Over here on the right you can see in our diagram that with weakness in the esophageal wall, anti-pressure eventually there's an outpouching that forms through the cricopharyngeal muscle in the upper third of the esophagus.

01:17 This outpouching is called the Zenker's diverticulum.

01:21 Patients may present with dysphagia, halitosis, they may have regurgitation of undigested food, chest pain, and chronic cough.

01:30 The diagnosis is made by doing a barium swallow and treatment is with a myotomy to relieve the high pressure and to correct the underlying motility disorder.

01:43 So now let's return to our case.

01:45 We have a 55-year-old man with chronic dysphagia, frequent regurgitation and halitosis, and a pretty normal physical exam.

01:53 So all of these thing should lead you to think about features of his esophageal diverticula and know that the best diagnostic step is a barium swallow.