Esophageal diverticula are caused by primary muscular abnormalities that may be congenital or by inflammatory processes adjacent to the esophagus. Zenker’s diverticulum results from developmental muscle weakness of the posterior pharynx above the border of the cricopharyngeal muscle. The pressure of swallowing aggravates this weakness, as does contraction of the pharynx before relaxation of the sphincter, resulting in development of diverticula.

A midesophageal diverticulum may be a response to scarring and pulling on esophageal walls by an external inflammatory process such as tuberculosis, or by traction from old adhesions. Another cause may be propulsion associated with esophageal motor abnormalities such as diffuse esophageal spasm. An epiphrenic diverticulum probably results from traction and pulsation or from esophageal motor disturbances, such as diffuse esophageal spasm and achalasia.

Regurgitation of saliva or food particles may lead to aspiration, causing pulmonary complications, such as bronchitis, bronchiectasis, and lung abscess. The disorder may also lead to esophageal perforation.

In the early stage of Zenker’s diverticulum, the patient may report recent weight loss, which he may attribute to difficulty eating. The patient’s history may reveal dysphagia and regurgitation of saliva and food particles soon after eating. In the later stage, the esophageal opening may be almost completely blocked. The patient may describe regurgitation of food particles he consumed several days earlier. He may also hear gurgling sounds in his neck when he’s swallowing liquids.