Let's move on to our next case.
We have 55-year-old man who presents to clinic complaining of several months of difficulty swallowing.
He notes mild chest discomfort immediately after swallowing.
He sometimes regurgitates undigested food and complains of bad breath.
He has lost 3 kg unintentionally.
He does not smoke or drink alcohol, and denies any symptoms of acid reflux.
On exam, vitals are normal. His abdominal exam and oropharyngeal exam are both unremarkable.
What is the best diagnostic step to confirm the diagnosis here?
So let's go through some key features.
He has chronic dysphagia, he has regurgitation and halitosis or bad breath, and a pretty normal physical exam.
So let's talk a bit about esophageal diverticula.
Esophageal diverticula can form due to muscular weakness in the esophageal wall
that usually results from an underlying motility disorder.
So the most common type here is called a Zenker diverticulum.
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.
This outpouching is called the Zenker's diverticulum.
Patients may present with dysphagia, halitosis, they may have regurgitation of undigested food, chest pain, and chronic cough.
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.
So now let's return to our case.
We have a 55-year-old man with chronic dysphagia, frequent regurgitation and halitosis, and a pretty normal physical exam.
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.