From the Guidelines
Retrograde cricopharyngeal dysfunction should be treated with cricopharyngeal myotomy as the most common and effective surgical treatment for oral-pharyngeal dysphagia characterized by hyperfunction of the upper esophageal sphincter, which results in hypopharyngeal retention of swallowed material and subsequent aspiration. This condition is a swallowing disorder characterized by the backward flow of food from the esophagus into the pharynx due to abnormal functioning of the cricopharyngeal muscle. Treatment typically involves a combination of dietary modifications, swallowing therapy, and sometimes medications or procedures. Patients should modify their diet to include softer foods, eat smaller meals more frequently, and remain upright for 30-60 minutes after eating. Swallowing therapy with a speech-language pathologist is recommended to learn techniques like the Mendelsohn maneuver or supraglottic swallow.
According to the American Gastroenterological Association guidelines 1, cricopharyngeal myotomy is the most common surgical treatment for oral-pharyngeal dysphagia characterized by hyperfunction of the upper esophageal sphincter. The operation is recommended for patients with dysphagia that is caused by structural abnormalities, but not for those with dysphagia caused by neurologic insult. Some key points to consider in the treatment of retrograde cricopharyngeal dysfunction include:
- Dietary modifications to reduce symptoms
- Swallowing therapy to improve swallowing function
- Medications to manage reflux or other contributing factors
- Cricopharyngeal myotomy as a surgical option for severe cases
- The importance of evaluating the underlying cause of dysphagia to determine the best course of treatment, as noted in the guidelines 1.
It is essential to prioritize treatments that address the underlying cause of the condition and minimize the risk of complications, such as aspiration and respiratory infections. By focusing on the most effective and evidence-based treatments, patients with retrograde cricopharyngeal dysfunction can experience improved symptoms and quality of life. The use of cricopharyngeal myotomy as a surgical treatment option is supported by the guidelines 1 and should be considered for patients with severe cases of retrograde cricopharyngeal dysfunction.
From the Research
Diagnosis of Retrograde Cricopharyngeal Dysfunction
- The diagnosis of retrograde cricopharyngeal dysfunction is based on clinical symptoms, including inability to belch, abdominal or chest pressure, odd gurgling noises, and occasional difficulty vomiting 2, 3, 4, 5, 6.
- Symptoms tend to worsen with carbonated beverages 2, 3.
- A set of clinical symptoms is used to diagnose the condition, including a standardized questionnaire 3.
- Patients may also experience bloating, awkward gurgling noises, and excessive flatulence 2, 3, 4, 5, 6.
Treatment of Retrograde Cricopharyngeal Dysfunction
- The recommended treatment for retrograde cricopharyngeal dysfunction is cricopharyngeus muscle botulinum toxin injections 2, 3, 4, 5, 6.
- Botulinum toxin injection can be performed in the operating room or in-office, with both methods showing equal effectiveness 4.
- The injection technique can be performed under general anesthesia using endoscopy or by transcutaneous injection with electromyographic control 5.
- Treatment outcomes have shown significant improvement in symptoms, with some patients experiencing complete relief of symptoms 3, 4, 6.
- Adverse effects of treatment may include dysphagia, which is more severe after operating room injections 4, 6.