dysphagia

A 65-year-old Caucasian male presents to your office with a several month history of swallowing difficulty. He also noticed the appearance of a mass on the right side of his neck recently that increases in size after he drinks water. His past medical history is significant for hypertension, gastroesophageal reflux disease, and osteoarthritis of his right knee. His current medications include hydrochlorothiazide, ranitidine, and occasional naproxene. You order a barium examination of the esophagus to visualize the abnormality. Which of the following is the most important pathogenetic factor in the development of this patient’s problem?
A. Motor dysfunction
B. Acid reflux
C. Inflammation
D. Abnormal proliferation
E. Metabolic abnormalities

correct answer is A

Explanation:
Pharyngoesophageal (Zenker’s) diverticulum develops immediately above the upper esophageal sphincter by herniating posteriorly between the fibers of cricopharyngeal muscle. Upper esophageal sphincter dysfunction and esophageal dysmotility are believed to be the cause of the problem. Incoordination between upper esophageal sphincter contraction and pharyngeal contraction may result in herniation of the mucosa by pulsion mechanism. The patients with Zenker’s diverticulum are usually older than 50 years of age and present with oropharyngeal dysphagia and neck mass. The neck mass may cause gurgling in the throat and may vary in the size depending on the food and fluid intake. The potential complications of the diverticulum include tracheal compression, ulceration with bleeding, regurgitation, and pulmonary aspiration. A barium examination helps to delineate the diverticulum. The surgical treatment of the disorder includes excision and frequently cricopharyngeal myotomy.
Although gastroesophageal reflux disease (Choice B) is frequently associated with Zenker’s diverticulum, it is not the cause of this condition. External inflammation (Choice C) may cause traction diverticula, usually in the mid-esophageal zone, but it is uncommon. Metabolic abnormalities, like iron deficiency (Choice E), may be associated with upper esophageal webs. Abnormal proliferation (Choice D) is responsible for neoplasia.