From the Guidelines
Metaclopramide is recommended as a prokinetic therapy for retrograde cricopharyngeus dysfunction, as evidenced by a strong consensus in the 2019 ESPEN guideline on clinical nutrition in the intensive care unit 1. When considering treatment for retrograde cricopharyngeus dysfunction, it's essential to weigh the potential benefits and risks of metaclopramide.
- The typical dosage of metaclopramide is 5-10 mg orally three times daily before meals for 4-12 weeks.
- However, treatment duration should be limited due to the risk of tardive dyskinesia with prolonged use.
- Patients should be monitored for side effects, including extrapyramidal symptoms, drowsiness, and restlessness. The mechanism of action of metaclopramide involves dopamine receptor antagonism and serotonin receptor agonism, which enhances gastric emptying and lower esophageal sphincter tone.
- Although its effect on the cricopharyngeus muscle specifically is less established, the strong consensus in the ESPEN guideline supports its use as a prokinetic therapy 1. Treatment of retrograde cricopharyngeus dysfunction typically requires a multidisciplinary approach, potentially including speech therapy, swallowing exercises, and consideration of other interventions such as botulinum toxin injection or surgical myotomy in severe cases.
- Addressing underlying conditions like gastroesophageal reflux disease may also be necessary for comprehensive management.
From the Research
Effectiveness of Metaclopramide in Treating Retrograde Cricopharyngeus Dysfunction
- There are no research papers to assist in answering this question, as the provided studies do not mention the use of metaclopramide in treating retrograde cricopharyngeus dysfunction.
- The studies 2, 3, 4, 5, 6 focus on the diagnosis and treatment of retrograde cricopharyngeus dysfunction using botulinum toxin injections, but do not discuss the effectiveness of metaclopramide.
Alternative Treatments for Retrograde Cricopharyngeus Dysfunction
- Botulinum toxin injections are a commonly used treatment for retrograde cricopharyngeus dysfunction, with studies showing significant improvement in symptoms 2, 3, 4, 5, 6.
- Cricopharyngeal myotomy is also a treatment option for patients with recurrent symptoms 4.
Diagnosis and Symptoms of Retrograde Cricopharyngeus Dysfunction
- Retrograde cricopharyngeus dysfunction is characterized by symptoms such as inability to belch, loud gurgling noises, chest and abdominal pain/distention, and excessive flatulence 2, 3, 4, 5, 6.
- Diagnosis is often made based on symptomatology, with some studies using high-resolution manometry and oesophagoscopy to confirm the diagnosis 5.