Diagnosis of Retrograde Cricopharyngeus Dysfunction Using High Resolution Impedance Manometry and Comparison With...

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Tools

Background:

• Retrograde cricopharyngeal dysfunction (R-CPD), characterized by an inability to belch, is associated with ineffective upper esophageal sphincter (UES) relaxation during gastroesophageal reflux.
• Botulinum toxin (BT) injection into the UES has shown promise in case series, but R-CPD is often overlooked.
• High-resolution impedance manometry (HRiM) with belch provocation is a newly suggested diagnostic method.

Purpose of the Study:

• To confirm manometric findings in patients with R-CPD before and after BT treatment.
• To compare HRiM findings in R-CPD patients with control groups and healthy volunteers.
• To validate HRiM with belch provocation as a diagnostic tool for R-CPD.

Main Methods:

• Retrospective analysis of HRiM with belch provocation in 100 participants (55 R-CPD patients, 30 controls, 15 healthy volunteers).
• Analysis of UES relaxation, air clearance, and air oscillations during gas reflux episodes.
• Repeat HRiM measurements in 29 R-CPD patients after BT treatment.

Main Results:

• R-CPD patients exhibited lower median esophageal contractility compared to controls and healthy volunteers.
• During belching, R-CPD patients showed higher UES pressures, leading to incomplete air clearance and esophageal air oscillations.
• BT injection significantly decreased median UES pressures during belching (56 to 3 mmHg) and improved air clearance (P < .0001).
• A maximum UES pressure during belching >31 mmHg effectively distinguished R-CPD patients from controls.

Conclusions:

• A rapid drinking challenge with sparkling water can effectively provoke belching during HRiM.
• Elevated UES pressures and esophageal air oscillations during gas reflux are key discriminators of R-CPD.
• HRiM with belch provocation is a valuable tool for diagnosing R-CPD and assessing treatment response.