Retrograde cricopharyngeal dysfunction

Retrograde cricopharyngeus dysfunction or R-CPD is a condition in which people are unable to burp.[1] It is a lifelong problem that is usually first noted in adolescence, but has also been reported as early as infancy. Most people with this condition also complain of frequent bloating, "gurgling noises" from the throat, frequent flatulence and poor tolerance to carbonated beverages.

A wide esophagus due to trapped air. This is common in R-CPD and causes chest pains, gurgles and other symptoms.This was done using an ENT scope without insufflated air.

The cricopharyngeus muscle is also described as the Upper esophageal sphincter. It is a circular muscle at the base of the throat, behind the larynx. The muscle is closed (actively contracting) at all times and opens for swallowing or to allow relief of pressure in the esophagus via burping or vomiting. In R-CPD, the swallowing function of the muscle is normal but the response to pressure in the esophagus is absent.

Treatments

The initial treatment of R-CPD is injection of Botox into the cricopharyngeus muscle. Botox will temporarily weaken or paralyze the muscle. The direct effects of Botox last for three months on average. For most patients with R-CPD, injection of Botox into the cricopharyngeus muscle will reverse the symptoms, and for many, the effect will last beyond the first three months. 30% of patients describe some swallowing difficulty after the injection that usually resolves after the first 3-4 weeks.

The first treatment is usually performed under general anesthesia. The procedure lasts 15-20 minutes and results in a mild sore throat. The effect of Botox is delayed for three days on average and most patients with successful results report the ability to burp by the fifth day after the procedure. Subsequent injections can be considered and administered with local anesthesia.[2]

An alternative if the injection is unsuccessful is to undergo partial cricopharyngeal myotomy.[3]

Treatment Success

A study from 2022 showed 88.2% efficacy of the Botox treatment. The most common side effect in the study was mild and temporary difficulty swallowing, which went away on its own. This affected 30.6% of the participants.[4]

References
  1. Bastian, R. W.; Smithson, M. L. (2019). "Inability to Belch and Associated Symptoms Due to Retrograde Cricopharyngeus Dysfunction: Diagnosis and Treatment". Oto Open. 3 (1): 2473974X19834553. doi:10.1177/2473974X19834553. PMC 6572913. PMID 31236539.
  2. "Retrograde Cricopharyngeus Dysfunction (R-CPD)". 26 September 2016.
  3. Bastian, R. W.; Hoesli, R. C. (2020). "Partial Cricopharyngeal Myotomy for Treatment of Retrograde Cricopharyngeal Dysfunction". Oto Open. 4 (2): 2473974X20917644. doi:10.1177/2473974X20917644. PMC 7163242. PMID 32328538.
  4. Siddiqui, Sana H.; Sagalow, Emily S.; Fiorella, Michele A.; Jain, Nikhita; Spiegel, Joseph R. (2023). "Retrograde Cricopharyngeus Dysfunction: The Jefferson Experience". The Laryngoscope. 133 (5): 1081–1085. doi:10.1002/lary.30346. PMID 36054518. S2CID 251782482.
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