[Retrograde cricopharyngeal dysfunction: clinical characteristics and endoscopic treatment using botulinum toxin-A]

Objectives: This study aims to investigate the features of retrograde cricopharyngeal dysfunction (RCPD) and to evaluate the effectiveness and safety of Botulinum toxin-A as a treatment for RCPD. Methods: Twenty-two RCPD patients admitted between February 2024 and November 2024 were included through online and offline methods in The Sixth Medical Centre of Chinese PLA General Hospital (15 males, 7 females, age range, 14-34 years; mean age 25.0±5.2 years). The general condition, symptoms, severity scores, and auxiliary examinations were summarized and analyzed. Operative results and postoperative complications of RCPD patients treated with Botulinum toxin-A were analyzed. Results: All patients could not burp since early childhood, followed by gurgling noises, abdominal flatulence, laryngopharyngeal foreign body sensation, and cervical constriction. The most severe symptom was the inability to burp with a mean score of 4.8. Seven patients who received botulinum toxin injections under the supporting laryngoscopes started burping six days post-operation. With a median follow-up of 5 months, all patients achieved the ability to belch. In none of these seven cases, intraoperative complications were noted including hoarseness, choking cough when drinking water, or dyspnea. One patient experienced laryngopharyngeal reflux and six patients had dysphagia, which were relieved at 1 week and 24.8 days postoperatively. Conclusion: RCPD is a disease characterized by the inability to burp, cricopharyngeal muscle injection by Botulinum toxin-A is effective and safe.