RESUMEN
OBJECTIVES: Retrograde Cricopharyngeal Dysfunction (RCPD) is treated by botulinum toxin (BTX) injection into the cricopharyngeus. This prospective study compares the effectiveness and side effects of operating room (OR) and in-office (IO) injections. METHODS: Patients over 18 years of age with inability to burp, abdominal, thoracic, or cervical gurgling sounds, bloating, and excessive flatulence were diagnosed with RCPD and included in the study. Injections were performed in the OR (80U) or IO (30U) by the senior author. An RCPD questionnaire quantifying major and minor symptoms on a Likert scale, Eating Assessment Tool-10 (EAT-10), and Generalized Anxiety Score-7 (GAD-7), were completed preinjection; at 1, 2, and 3 weeks; and 3 months postoperatively. Linear mixed models were used to analyze effects of BTX injection on RCPD symptoms, the EAT-10, and the GAD-7. RESULTS: 108 (55 M/53F) patients completed the pretreatment survey, 53 (31 OR vs. 22 IO) completed the 3-week follow-up, and 36 (22 OR vs. 14 IO) completed the 3-month questionnaire. Average posttreatment RCPD scores were significantly lower in both groups at 3 weeks and 3 months (p < 0.0001), There was no difference between IO or OR (p = 0.4924). GAD-7 scores were significantly lower in both groups at week 3 (p = 0.0018) and month 3 (p = 0.0012). Postinjection EAT-10 scores were significantly higher in OR compared with IO (p = 0.0379). CONCLUSION: OR and IO injections are equally effective in the treatment of RCPD. Postinjection dysphagia is more severe after the OR injections which may be related to higher doses of BTX used. General anxiety levels decrease with treatment. LEVEL OF EVIDENCE: 2 Laryngoscope, 2024.
RESUMEN
Retrograde cricopharyngeal dysfunction (RCPD), also referred to as retrograde cricopharyngeus dysfunction, is a condition characterized by the inability to burp. The pathophysiology of this condition is thought to result from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension, which leads to patients' bothersome symptoms. RCPD negatively impacts patients' quality of life and is associated with bloating, gurgling, avoidance of carbonation, self-imposed dietary and lifestyle changes designed to minimize discomfort, and flatulence. Complaints often start during adolescence, and many patients search for a diagnosis for years before obtaining treatment. A recent increase in awareness through patient-led social media discussion boards describing the 'no burp' syndrome is leading to an increasing incidence of presentations, often with patients making a self-diagnosis. The increased incidence of RCPD is fueling a larger case series investigating treatment options and outcomes. In this review, we discuss what is known about the pathophysiology of this condition, the otolaryngologic perspective on diagnosis and treatment, the patients' lived experience of this condition, and the influence of social media on RCPD.
RESUMEN
OBJECTIVE: Operating room (OR) injection of botulinum toxin (BTX) injection is effective in the management of retrograde cricopharyngeal dysfunction (RCPD). This study aims to analyze the efficacy and safety of in-office (IO) 30 Unit BTX injection into the cricopharyngeus via lateral transcervical approach. METHODS: A retrospective chart review of patients who underwent BTX injection either in the OR or IO for RCPD was performed. Postoperative success, defined by patient-reported complete or near complete resolution of symptoms, side effects, and complication rates of each group was determined and compared. To determine the learning curve of IO injections, success rates of the injections performed in the early and late 6 months were compared. Chi-square test was used for determining the statistical significance. RESULTS: Overall, 78 injections (37 IO and 41 OR) for RCPD were performed by the senior author. The success rate of OR injections (90.2%) is significantly higher than IO injections (64.9%) at the first-month follow-up (p = 0.022). No significant difference was found in the side effect rates. Success and side effect rates were also similar in early and late injections (p > 0.05). CONCLUSIONS: IO lateral transcervical BTX injection for RCPD is a safe method that does not require general or topical anesthesia. While the side effects are similar and IO injections have many advantages, the success rates are lower than OR injections. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:283-286, 2024.
Asunto(s)
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Fármacos Neuromusculares , Humanos , Estudios Retrospectivos , Inyecciones , Esfínter Esofágico Superior , Quirófanos , Resultado del TratamientoRESUMEN
Retrograde cricopharyngeal dysfunction is a newly described syndrome characterized by the inability to belch, loud abdominal gurgling, excessive flatulence, and pain or distension of the low neck, chest, or abdomen. Treatment is with botulinum toxin injection into the cricopharyngeus muscle. We present a pediatric case of this syndrome to increase awareness among the medical community and for clinicians to expand their index of suspicion for retrograde cricopharyngeal dysfunction.
RESUMEN
OBJECTIVE: Retrograde cricopharyngeal dysfunction was recently described by Bastian in 2019 and is characterized by an inability to belch, abdominal or chest pressure, odd gurgling noises, and occasional difficulty vomiting. Symptoms tend to worsen with carbonated beverages. Currently, the recommended treatment is cricopharyngeus muscle botulinum toxin injections. Prior studies have included few pediatric patients within larger datasets comprised primarily of adults. We describe our preliminary experience in pediatric patients, including presenting symptoms, treatment approach, and post-treatment outcomes. METHODS: Retrospective chart review of pediatric patients (aged <18 years) diagnosed with retrograde cricopharyngeal dysfunction based on clinical history by the senior author. Medical records were reviewed for presenting symptoms, prior testing and treatment, details of treatment, and postoperative outcomes. RESULTS: Five patients with average age of 14 ± 4 (3 females, 2 males) were included. Presenting symptoms included lifelong or nearly lifelong inability to burp (n = 5), bloating (n = 5), awkward gurgling noises (n = 3), and worsening of symptoms with carbonated beverages (n = 5). Two patients had prior normal upper endoscopy. All patients underwent cricopharyngeal botulinum toxin injection under general anesthesia, with 25-50 units of botulinum toxin injected to the posterior cricopharyngeus across 4-5 locations. All patients had resolution of symptoms with follow-up of 1.5-10 months. CONCLUSIONS: Retrograde cricopharyngeal dysfunction may be underdiagnosed due to lack of awareness of the condition. Now that the phenomenon of inability to belch has a name and is being reported in the literature, we will likely see more adult and pediatric patients with these symptoms. Pediatric patients may respond similarly to adults. Larger studies with longer-term follow-up and targeted patient-reported outcome measures are needed to characterize disease presentation and treatment outcomes.
Asunto(s)
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Trastornos de Deglución , Adolescente , Toxinas Botulínicas/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Niño , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Esfínter Esofágico Superior , Femenino , Humanos , Masculino , Músculos Faríngeos/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Retrograde cricopharyngeal dysfunction (R-CPD) is a recently described disorder characterized by an inability to belch, excessive flatulence, unpleasant gurgling noises, and discomfort in the lower neck, chest, and abdomen. Herein, we describe a case of R-CPD in a 19-year-old man. The patient suffered from flatulence and was unable to belch since birth; auxiliary examination of his digestive system was normal. He was diagnosed with R-CPD based on clinical manifestations and laboratory results. He received an injection of botulinum toxin to the cricopharyngeal muscle under ultrasound, catheter balloon, and electromyographic guidance. His symptoms completely resolved 1 week after the injection.
RESUMEN
CASE SERIES: This is retrospective case series involving 72 patients who presented with symptoms associated with inability to burp. The following symptoms was described by almost all the patients; retrosternal pain after eating or drinking, bloating feeling in the stomach, gurgling noise in the throat, excessive flatulence. These symptoms are worse with fizzy/carbonated drinks and beer. A full clinical history and examination plus endoscopic and in some cases barium a swallow radiological investigation was done. PROCEDURE: The surgery was performed under a general anaesthesia for all cases. Suspension pharyngoscopy in supine position using a Weerda diverticuloscope to identify the cricopharyngeal bar muscle. High dose of botulinum toxin A (botox) 100 iu was injected into the cricopharynxgeus muscle under a general anaesthesia. RESULTS: A total of 72 patients were diagnosed and undergone surgery between November 2016 and December 2020. There were 50 male and 22 female patients. Their average age was 30 (range 18-68 years old). All patients were able to burp again within first 4 weeks of the injection. This persisted even after the Botox worn off beyond the 3 months in 96% of cases. The average follow-up was 24 months post injection with longest follow-up 48 months (range 1-48 months). CONCLUSION: The author reported a new condition of inability to burp due to failure of the cricopharyngeal sphincter to relax spontaneously and outcome of treatment using botulinum toxin A injection into the cricopharyngeus muscle. It is expected that the paralysing action of botulinum toxin injection last approximately 3 months. However, this group of patients seem to be cured even after the effect of the botox is worn off. The author therefore postulated that there might me some neural dysfunction that inhibits the brain to send signals to the cricopharyngeal sphincter to initiate burping. Once burping is re-established with the help of botox injection, spontaneous burping seems to occur and sustained even after the botox is worn off.