Retrograde cricopharyngeal dysfunction management with botulinum toxin A.

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.