Retrograde cricopharyngeus dysfunction: what the gastroenterologist should know.

Area of Science:

• Gastroenterology
• Otolaryngology
• Clinical Medicine

Background:

• Retrograde cricopharyngeus dysfunction (R-CPD) is a condition characterized by the inability to burp, often accompanied by gastrointestinal symptoms.
• R-CPD may affect up to 22% of the population, with symptoms frequently beginning in childhood but diagnosed years later.
• Strong associations exist between R-CPD and gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD), with potential bidirectional causality.

Purpose of the Study:

• To review the current literature on the etiology, pathophysiology, clinical presentation, and management of retrograde cricopharyngeus dysfunction (R-CPD).

Main Methods:

• Literature review of studies on R-CPD.
• Analysis of R-CPD etiology, pathophysiology, clinical presentation, and management strategies.
• Evaluation of treatment outcomes, particularly botulinum toxin injection (BTI).

Main Results:

• R-CPD is linked to GERD/LPRD, with a possible genetic predisposition suggested by family history in 28% of cases.
• Botulinum toxin injection (BTI) into the cricopharyngeal sphincter shows high initial success rates (up to 92.5%) via various techniques.
• Factors like younger age, higher BTI doses, and general anesthesia correlate with better outcomes, though recurrence rates range from 4-45%.

Conclusions:

• R-CPD is an underrecognized condition significantly impacting quality of life.
• Botulinum toxin injection (BTI) is an effective and safe treatment for R-CPD.
• Standardized diagnostic criteria, treatment protocols, and pediatric studies for R-CPD are essential.