What is a pharyngeal pouch?

A pharyngeal pouch is a small bulge that forms at the top of your food pipe (oesophagus), in the lower part of your throat behind your voice box. It is also known as a Zenker’s diverticulum.

It can happen when the muscle at the top of the food pipe doesn’t relax properly to let food and drink through. This is thought to happen due to ageing and acid reflux. When this muscle doesn’t relax and open properly, then pressure builds up. Over time, this can push out a weak spot in the wall of the throat (known as the pharyngeal wall), creating a pouch.

Pharyngeal pouch

They usually grow slowly, and it can be many years before it causes you any problems. If the pouch becomes large, it can cause more symptoms.

What symptoms might you notice?

Food and drink can get trapped in the pouch rather than going straight into the food pipe and down to the stomach. You might notice:

• difficulty swallowing
• feeling like food is stuck or a lump in the throat
• bad breath
• coughing or choking after eating
• undigested food coming back up (regurgitation)
• sometimes weight loss if eating becomes uncomfortable.

How is it diagnosed?

Usually with a barium swallow – an x-ray where you drink a special liquid.

Sometimes pouches are found by accident during this test when you are being investigated for a different problem.

What are the options for treatment?

If your symptoms are severe, your GP may refer you to an Ear Nose and Throat (ENT) specialist. Treatment often involves surgery using an endoscope (a thin tube down your throat) to open or staple the pouch. This often works well.

Managing symptoms without surgery

• If your symptoms are mild or surgery isn’t possible, these tips can help:
• keep a diary of foods that cause problems
• if a texture is difficult, try chewing it well and making it softer with sauces or gravy
• eat slowly and focus while eating
• take sips of drink between mouthfuls
• sit upright while eating and for 1 hour after
• eat smaller meals more often
• try tucking your chin down or turning your head when swallowing to see if it helps
• if certain foods are still too difficult, you may need to avoid them and find alternatives that are easier.

When to seek medical help

Contact your doctor if:

• you cough or choke regularly when eating
• you have frequent chest infections
• you are losing weight or struggling to eat enough
• you notice pain or blood in food that comes back up.

Further information

Pharyngeal pouch entuk

or search for ‘pharyngeal pouch ENT UK’