Retrograde cricopharyngeal dysfunction: Two case reports and a literature review

Area of Science:

• Otolaryngology
• Gastroenterology
• Neurology

Background:

• Retrograde cricopharyngeal dysfunction (RCPD) is an emerging condition characterized by the inability to belch.
• Patients often self-diagnose RCPD after extensive, inconclusive investigations, indicating low clinician awareness.
• Lifelong inability to belch is a key symptom, often accompanied by previous unrevealing diagnostic evaluations.

Purpose of the Study:

• To present two distinct cases of RCPD management.
• To highlight diagnostic findings using high-resolution manometry.
• To discuss potential treatment avenues for RCPD.

Main Methods:

• Case 1: Medical management of a 17-year-old male with rikkunshito and mosapride.
• Case 2: Endoscopic cricopharyngeal myotomy for a 30-year-old female with refractory symptoms.
• Diagnostic confirmation via high-resolution manometry showing elevated UES pressure and absent relaxation during attempted belching.

Main Results:

• Successful symptom relief in both patients following distinct treatment strategies.
• Rikkunshito and mosapride provided effective medical management for one patient.
• Endoscopic cricopharyngeal myotomy offered a definitive solution for refractory symptoms after temporary botulinum toxin relief.

Conclusions:

• Increased clinician awareness of RCPD is crucial to prevent prolonged diagnostic odysseys.
• Rikkunshito may serve as an alternative adjunct therapy for patients avoiding procedures.
• Cricopharyngeal myotomy is a viable surgical option for refractory RCPD cases or those intolerant to injections.