Pediatric retrograde cricopharyngeal dysfunction diagnosed by high-resolution impedance manometry

Area of Science:

• Gastroenterology
• Pediatric Medicine
• Otolaryngology

Background:

• Retrograde cricopharyngeal dysfunction (R-CPD) is a condition characterized by the inability to burp, often presenting with symptoms like abdominal bloating, nausea, and chest pain.
• While R-CPD has been described in adults, its clinical and diagnostic features, particularly using high-resolution esophageal impedance-manometry (HRIM), have not been well-documented in pediatric populations.
• Botulinum toxin injection into the cricopharyngeal muscle has shown promise in treating R-CPD in adults.

Purpose of the Study:

• To describe the clinical presentation and HRIM findings in pediatric patients diagnosed with R-CPD.
• To characterize the specific manometric abnormalities associated with R-CPD in adolescents.
• To evaluate the efficacy of botulinum toxin treatment in this age group.

Main Methods:

• A retrospective review of five pediatric patients diagnosed with R-CPD was conducted.
• Patients' clinical and manometric data were analyzed.
• A modified HRIM protocol, including the ingestion of a carbonated beverage, was used to elicit symptoms and identify characteristic manometric patterns.

Main Results:

• Five female patients aged 15-20 years presented with inability to burp and involuntary throat sounds.
• HRIM revealed normal upper esophageal sphincter (UES) relaxation during swallowing but abnormal relaxation with high esophageal impedance after a carbonated drink, indicating air entrapment and secondary peristalsis.
• Four patients had esophageal motility disorders, and all experienced symptom improvement or resolution following botulinum toxin injection.

Conclusions:

• Adolescents presenting with inability to burp, reflux-like symptoms, bloating, and throat noises should be evaluated for R-CPD by pediatric gastroenterologists using HRIM.
• The findings highlight the utility of HRIM in diagnosing R-CPD in adolescents.
• Underdiagnosis of R-CPD in children may be attributed to its recent recognition and lack of established diagnostic criteria in this population.