Behavioral Eructation Retraining Protocol (BERP): A Novel Adjunct Behavioral Therapy for R-CPD

Botulinum injection into the cricopharyngeus (CP) muscle is the current standard of treatment for retrograde cricopharyngeus dysfunction (R-CPD), resulting in lasting symptom resolution for up to 80% of patients. Individuals with incomplete symptom relief after CP botulinum toxin (BTX) injection have few treatment options, including repeat BTX injection, dilation, or myotomy. Investigators sought to explore behavioral intervention to facilitate eructation retraining for individuals with incomplete response to CP BTX injections.

This is a retrospective case series of seven individuals with R-CPD who experienced incomplete symptom resolution following injection or experienced symptom recurrence after BTX wore off. They participated in speech-language pathology intervention focused on training patients to achieve a body position that facilitates eructation, called the Behavioral Eructation Retraining Protocol (BERP). Alongside counseling and education, BERP includes teaching the patient to achieve a position with the following features: laryngeal lowering, jaw protrusion, head turn and tuck, and torso anchoring.

Six of the seven patients achieved durable R-CPD symptom resolution with a combination of CP BTX injection and BERP therapy. Notable subjective patient reports include feeling "100% cured" and having become "a burping machine." Six of the seven demonstrated successful eructation while implementing BERP positioning during their initial appointments. One patient in this series continues to undergo treatment for unresolved R-CPD symptoms.

BERP is a promising adjunct intervention option for individuals with incomplete response to CP BTX injections. Future research will prospectively examine the efficacy of BERP as an adjunct to CP BTX in the treatment of R-CPD.