From the Guidelines
For patients with a cricopharyngeal bar, upper oesophageal sphincter dilatation using either balloon or bougie methods is a recommended treatment option to relieve symptoms of dysphagia. This approach is supported by the UK guidelines on oesophageal dilatation in clinical practice, which suggest considering upper oesophageal sphincter dilatation in the treatment of dysphagia with disordered upper oesophageal sphincter opening, including cricopharyngeal bar with or without the presence of a Zenker’s diverticulum 1.
The treatment of cricopharyngeal bar aims to alleviate symptoms of dysphagia by addressing the underlying issue of disordered upper oesophageal sphincter opening. Key considerations in managing cricopharyngeal bar include:
- Symptom severity: Patients with severe symptoms may require more invasive interventions, while those with mild symptoms may be managed conservatively.
- Patient comorbidities: The presence of comorbid conditions may influence the choice of treatment, with a focus on minimizing risks and optimizing outcomes.
- Functional status: The patient's overall functional status and ability to undergo certain procedures should be taken into account when selecting a treatment option.
In the context of cricopharyngeal bar, the evidence suggests that upper oesophageal sphincter dilatation is a viable treatment option, with a moderate grade of evidence and a strong strength of recommendation 1. This approach can be used to relieve symptoms of dysphagia and improve quality of life for patients with cricopharyngeal bar.
From the Research
Treatment Options for Cricopharyngeal Bar
The treatment options for cricopharyngeal bar include:
- Esophageal dilation, which can produce long-term relief of dysphagia 2
- Cricopharyngeal peroral endoscopic myotomy (C-POEM), a novel procedure that has shown technical and clinical success in treating symptomatic cricopharyngeal bar 3
- Botulinum toxin injection into the cricopharyngeal muscle, which has been successful in improving swallowing function 4
- Surgical cricopharyngeal muscle myotomy, which can provide more lasting relief of dysphagia compared to dilation 5
- Swallowing therapy, which may include exercises such as the Shaker, effortful swallow, and Mendelsohn maneuver 6
Comparison of Treatment Options
- A study comparing surgical myotomy and dilation found that both treatments led to similar initial improvement in swallow function, but dilation was more likely to provide temporary benefit 5
- C-POEM has been shown to be a safe and effective treatment option, but it should be undertaken by experienced endoscopists 3
- Botulinum toxin injection has been shown to be effective in treating cricopharyngeal dysfunction, particularly in patients with isolated cricopharyngeal muscle hypertonicity or spasticity 4
Considerations for Treatment
- The choice of treatment may depend on the individual patient's condition and medical history
- Patients with more severe or persistent dysphagia may require more invasive treatments such as surgical myotomy or C-POEM
- Patients with less severe dysphagia may be treated with esophageal dilation or botulinum toxin injection 2, 4, 5