Which statement best describes the typical presentation of Zenker's diverticulum?

• A. Heartburn and regurgitation with reflux.
• B. Nausea and weight gain.
• C. Dysphagia, regurgitation of undigested food, halitosis, coughing, and sometimes aspiration.
• D. Coughing without regurgitation.

Answer: (C)

Zenker's diverticulum is a pouch that forms at the pharyngoesophageal junction, usually due to cricopharyngeus dysfunction, so swallowed food can get trapped in the pouch. The best description of its typical presentation includes dysphagia, regurgitation of undigested food, foul halitosis, coughing, and sometimes aspiration. Dysphagia comes from the pouch interfering with normal swallowing, while regurgitation happens because material sits in the diverticulum and is later expelled, which also explains the bad breath from stagnated contents. Coughing and potential aspiration occur when regurgitated material enters the airway, especially during sleep or at night. This combination is distinct from heartburn or reflux, which are more about acid reflux into the esophagus, not a pouch that holds and regurgitates food.