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

Area of Science:

• Otolaryngology
• Speech-Language Pathology
• Gastroenterology

Background:

• Retrograde cricopharyngeus dysfunction (R-CPD) is often treated with botulinum toxin (BTX) injections into the cricopharyngeus (CP) muscle.
• Up to 20% of patients experience incomplete symptom relief or recurrence after CP BTX injection, necessitating alternative treatments.

Purpose of the Study:

• To explore the efficacy of a behavioral intervention, the Behavioral Eructation Retraining Protocol (BERP), as an adjunct therapy for R-CPD patients with incomplete response to CP BTX injections.

Main Methods:

• A retrospective case series involving seven individuals with R-CPD who had suboptimal outcomes with CP BTX injection.
• Patients underwent speech-language pathology intervention (BERP) focused on achieving a specific body position to facilitate eructation, including laryngeal lowering, jaw protrusion, head turn and tuck, and torso anchoring.

Main Results:

• Six of the seven patients achieved durable R-CPD symptom resolution with the combination of CP BTX and BERP therapy.
• Five patients reported significant subjective improvement, with one noting complete resolution.
• Six patients successfully demonstrated eructation using BERP positioning during initial therapy sessions.

Conclusions:

• The Behavioral Eructation Retraining Protocol (BERP) is a promising adjunct therapy for R-CPD patients with incomplete response to CP BTX injections.
• Further prospective research is warranted to validate BERP's efficacy as an adjunct to CP BTX in R-CPD treatment.