title: Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis.
abstract: A cause-and-effect relation between gastroesophageal reflux disease and Zenker diverticulum remains unclear. Convincing evidence exists demonstrating that patients with Zenker diverticula have increased resting tone of the cricopharyngeus muscle, and that this may be an important initiating factor for the development of Zenker diverticula. Yet some patients with cricopharyngeus hypertonicity never develop Zenker diverticulum. In this context, we hypothesize that acid-induced esophageal shortening may be an important cofactor. We suggest that acid reflux induces longitudinal esophageal shortening, which in turn increases the risk for the development of herniation between 2 spatially related structures, the pharyngeal constrictors and cricopharyngeus muscles, leading to the development of Zenker diverticulum. This hypothesis awaits clinical verification.
authors.affiliation: Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA.
authors.forename: Clarence T
authors.initials: CT
authors.lastname: Sasaki
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Ross
authors.forename: Jagdeep
authors.initials: J
authors.lastname: Hundal
mesh_terms: D005764:Gastroesophageal Reflux / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D014057:Tomography, X-Ray Computed; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging / Q000209:etiology*