ZENKERS DIVERTICULUM IN THE ELDERLY - A NEUROLOGIC ETIOLOGY

Though described in 1769, the etiology of Zenker's diverticulum remain s unclear. Various primary esophageal motor disorders have been propos ed, but no consistent manometric pattern or anatomic etiology has been uniformly recognized. An association with clinical neurologic disease at our institution prompted a review of 12 cases of Zenker's divertic ulum in patients over 60 years of age, treated in the last 8 years. Ni ne patients (75%) underwent cricopharyngeus myotomy and diverticulecto my, with uniformly good results. Ten patients (83%) had an associated neurologic disorder, substantiated by cranial CT or MRI, in most cases . A wide range of neurologic problems were identified, but a strong tr end toward brainstem or basilar lesions was present. As expected, the etiology of the neurologic abnormality in most patients in this group was cerebrovascular disease, but two patients had peripheral neuropath ies. We suggest that the etiology of Zenker's diverticulum in the elde rly may be neurologic in origin. Esophageal motor disorders, including incomplete upper esophageal sphincter opening and increased hypophary ngeal pressures, which may result in Zenker's diverticulum, may be a m anifestation of central or peripheral neurologic disease in the elderl y.