Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction: A Prospective Cohort Study

Area of Science:

• Otolaryngology
• Gastroenterology
• Neurology

Background:

• Retrograde cricopharyngeal dysfunction (RCPD) is a condition characterized by an inability to belch and associated gastrointestinal symptoms.
• Botulinum toxin (BTX) injection into the cricopharyngeus muscle is a primary treatment for RCPD.

Purpose of the Study:

• To compare the effectiveness and side effects of botulinum toxin (BTX) injections for retrograde cricopharyngeal dysfunction (RCPD) administered in an operating room (OR) versus an in-office (IO) setting.
• To evaluate the impact of OR versus IO BTX injections on RCPD symptoms, swallowing function, and anxiety levels.

Main Methods:

• A prospective study included patients over 18 diagnosed with RCPD based on symptoms like inability to burp, gurgling sounds, bloating, and flatulence.
• Patients received either OR (80U) or IO (30U) BTX injections.
• Symptom severity, the Eating Assessment Tool-10 (EAT-10), and the Generalized Anxiety Score-7 (GAD-7) were assessed pre-injection and at multiple follow-up points up to 3 months post-procedure.

Main Results:

• Both OR and IO BTX injections significantly reduced RCPD symptoms and GAD-7 scores at 3 weeks and 3 months post-treatment (p < 0.0001).
• No significant difference in treatment effectiveness was observed between the OR and IO groups (p = 0.4924).
• Postinjection EAT-10 scores, indicating swallowing difficulty, were significantly higher in the OR group compared to the IO group (p = 0.0379).

Conclusions:

• Operating room and in-office botulinum toxin injections demonstrate comparable efficacy in treating retrograde cricopharyngeal dysfunction.
• In-office injections may be associated with a lower incidence or severity of post-treatment dysphagia compared to operating room injections, potentially due to lower BTX dosage.
• Treatment for RCPD with BTX leads to a reduction in general anxiety levels.