In most cases, a Zenker's diverticulum is caused by too much pressure in the
cricopharyngeus muscle due to hypertrophy (pulsion diverticulum). To simply
remove the diverticulum without cutting the muscle usually leads to
recurrence of the Zenker's diverticulum, so cricopharyngeal myotomy has
always been a component of a Zenker's diverticulectomy.

The barrier to reflux is the lower esophageal sphincter, at the other end of
the esophagus and the cricopharyngeus only acts as a secondary barrier to
getting that refluxate into the posterior pharynx. A cricopharyngotomy won't
cause, or even exacerbate esophageal reflux, but in someone who already has
significant GERD, it may exacerbate the problem by now allowing that reflux
into the posterior pharynx and thereby contributing to reflux larygitis
and/or microaspiration. And not everyone with acid reflux actually refluxes
into the upper esophagus.

I would be concerned about cricopharyngotomy in someone who already had
severe GERD and needed their Zenker's diverticulum addressed, but I would be
less concerned if the person didn't already have severe GERD. If I were in
doubt, I would recommend a 48 hour pH test with acid sensors in the lower
esophagus AND in the upper esophagus, as well as esophageal manometry to
look at resting pressures in the lower esophageal sphincter AND look at
pressures in the cricopharyngeus muscle. If I found that they had
significant esophageal reflux, I would be inclined to recommend an
anti-reflux procedure such as a laparoscopic Nissen fundoplication or a
Stretta procedure before doing the Zenker's diverticulectomy /
cricopharyngotomy.

HMc

Howie's going a bit overboard. The Zenker's is basically a congenital
anomaly of the cricopharyngeus which causes the diverticulum to occur.
Having it at 47 yrs. isn't all that unusual. It has nothing to do, other
than random chance, with GERD, though, if untreated, it will cause GERD
symptoms. The treatment, if it symptomatic, is to remove it, and cut the
cricopharyngeal muscle to relax the passage of food into the esophagus.
The decision about surgery would depend on your symptoms. It is unlikely
you would have to address the lower, or cardioesophageal sphincter at
the same time.