title: Zenker's diverticulitis secondary to alendronate ingestion: a rare cause of recurrent dysphagia.
abstract: OBJECTIVE
  Acute dysphagia/odynophagia developed in a 79-year-old female patient secondary to what we believe was a caustic injury to a large Zenker's diverticulum (ZD) in the setting of long-term alendronate use. She reported severe dysphagia and odynophagia of 1-week duration. She had experienced a similar episode 10 months earlier that had resolved after stopping alendronate temporarily. Although she was able to handle secretions, she was unable to swallow solids or liquids. She was noted to be dehydrated. On endoscopy, a large and markedly inflamed ZD was identified. There was no visual esophageal mucosal injury within the esophagus. Alendronate therapy was discontinued, and parenteral nutrition and proton pump inhibitors were initiated. Her symptoms resolved within 1 week, and she was able to resume oral intake.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University Hospital.
  
  
  CONCLUSIONS
  Case report.
  
  
  CONCLUSIONS
  Bisphosphonate therapy is commonly used to treat osteoporosis and is therefore an increasingly prevalent component of the medication list of elderly patients. These medications may cause significant caustic injury and are therefore administered with strong caution in the setting of dysphagia or known structural abnormalities of the esophagus. The fear is that tablets may become entrapped within a diverticulum and lead to intense acute inflammatory changes.
  
  
  CONCLUSIONS
  Health care providers should be aware of potential complications with ulcerogenic medications in patients with ZD. These medications should be administered with caution in the setting of dysphagia or known structural abnormalities of the esophagus. When patients with history of dysphagia are evaluated for their suitability to receive oral bisphosphonate therapy, care should be taken to investigate the etiology of dysphagia. Evaluation should focus not only on the tubular esophagus, but also on excluding a Zenker's pharyngeal diverticulum with appropriate contrast imaging.
authors.affiliation: University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: DeCross
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004238:Diverticulitis / Q000139:chemically induced* / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D016672:Zenker Diverticulum / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate