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Botulinum toxin A effectively treats retrograde cricopharyngeal dysfunction (R-CPD), enabling patients to belch. While 50 IU provided relief for many, some required higher doses for sustained symptom improvement.

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Area of Science:

  • Otolaryngology
  • Gastroenterology

Background:

  • Retrograde cricopharyngeal dysfunction (R-CPD) is characterized by an inability to belch due to impaired upper esophageal sphincter relaxation.
  • Botulinum toxin A injections present a promising therapeutic option for R-CPD, yet standardized treatment protocols are currently lacking.

Purpose of the Study:

  • This study aimed to evaluate the efficacy and safety of botulinum toxin A for treating R-CPD within a Danish patient cohort.

Main Methods:

  • A retrospective case series was conducted at Aarhus University Hospital, involving R-CPD patients treated between January 2021 and December 2024.
  • Diagnosis was clinical, confirmed by otorhinolaryngological examination, modified barium swallow, and esophagoscopy.
  • Patients received 50 IU of botulinum toxin A via cricopharyngeal muscle injection under general anesthesia, with assessments at two weeks and three months.

Main Results:

  • Out of 40 patients, 35 reported symptom relief within two weeks post-treatment.
  • At three months, 18 patients maintained the ability to belch.
  • Thirteen patients required dose escalation to 75-100 IU, with 24 achieving satisfactory outcomes and nine awaiting further procedures.

Conclusions:

  • Botulinum toxin A is a safe and effective treatment for R-CPD, associated with minor, transient side effects like dysphagia and sore throat.
  • Over half of the patients experienced improvement with an initial 50 IU dose.
  • Approximately one-third of patients necessitated dose escalation, indicating that higher doses (up to 100 IU) may improve treatment outcomes.