From the Guidelines
A cricopharyngeal bar is a prominent ridge-like protrusion of the cricopharyngeus muscle that can be seen during imaging studies of the throat, particularly during barium swallow examinations, and can cause symptoms such as difficulty swallowing, sensation of food getting stuck in the throat, coughing during meals, or regurgitation. This muscle forms the upper esophageal sphincter, which normally relaxes during swallowing to allow food to pass from the pharynx into the esophagus. When the cricopharyngeus muscle fails to relax properly or becomes hypertrophied (enlarged), it creates a visible indentation or "bar" on the posterior wall of the pharynx.
Key Points
- Cricopharyngeal bars can be asymptomatic and represent a normal variant in some individuals, especially older adults 1.
- The significance of a cricopharyngeal bar depends on whether it's causing symptoms and how severely it obstructs the passage of food.
- Treatment options for symptomatic cases include swallowing therapy, botulinum toxin injections to relax the muscle, or surgical myotomy (cutting of the muscle) in severe cases that don't respond to conservative measures.
- According to the UK guidelines on oesophageal dilatation in clinical practice 1, upper oesophageal sphincter dilatation can be considered in the treatment of dysphagia with disordered upper oesophageal sphincter opening, post-cricoid web, cricopharyngeal bar with or without the presence of a Zenker’s diverticulum.
Treatment Considerations
- The choice of treatment depends on the severity of symptoms and the presence of any underlying conditions 1.
- Upper oesophageal sphincter dilatation is a recommended treatment option for cricopharyngeal bar with associated dysphagia, with a moderate grade of evidence and a strong strength of recommendation 1.
- Other treatment options, such as swallowing therapy and botulinum toxin injections, may also be considered, but the evidence for these treatments is less strong 1.
From the Research
Definition of Cricopharyngeal Bar
- A cricopharyngeal bar (CPB) is a posterior indentation at the pharyngoesophageal junction that becomes apparent during a Video Fluoroscopic Swallowing Exam (VFSE) or modified barium swallow 2.
- It is often associated with dysphagia, but its appearance does not automatically represent the cause of dysphagic symptoms 2.
Pathogenesis and Biomechanics
- The pathogenesis of cricopharyngeal bars is thought to be related to reduced muscle compliance, where the relaxed cricopharyngeus does not distend normally during swallowing 3.
- Patients with cricopharyngeal bars may show normal peristaltic contraction in the pharynx, normal axial upper esophageal sphincter pressure and relaxation, and normal flow rate across the upper esophageal sphincter 3.
- However, they may also exhibit reduced maximal dimensions of the upper esophageal sphincter during the transsphincteric flow of barium and increased intrabolus pressure upstream to the upper esophageal sphincter 3.
Treatment Options
- Treatment options for cricopharyngeal bars include cricopharyngeal myotomy, esophago-gastro endoscopy using either bougies or balloons 2, and peroral endoscopic myotomy (c-POEM) 4.
- Esophageal dilation can also produce long-term relief of dysphagia in patients with symptomatic cricopharyngeal bar 5.
- Cricopharyngeal myotomy can be effective in improving dysphagia in patients with primary cricopharyngeal muscle dysfunction, but its effectiveness may vary depending on the individual patient 6.