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. 2019 Mar 15;3(1):2473974X19834553.
doi: 10.1177/2473974X19834553. eCollection 2019 Jan-Mar.

Inability to Belch and Associated Symptoms Due to Retrograde Cricopharyngeus Dysfunction: Diagnosis and Treatment

Robert W Bastian  1 , Melissa L Smithson  1
Affiliations

Inability to Belch and Associated Symptoms Due to Retrograde Cricopharyngeus Dysfunction: Diagnosis and Treatment

Robert W Bastian et al. OTO Open. .

Abstract

Objective: To propose and test the validity of a new syndrome called retrograde cricopharyngeus dysfunction (R-CPD) that explains inability to belch and the associated symptoms of loud gurgling noises, chest and abdominal pain/distention, and excessive flatulence, as well as to report the results of botulinum toxin (BT) injection into the cricopharyngeus muscle (CPM) for both diagnosis and treatment of R-CPD.

Study design: To develop a case series of consecutive patients matched to the syndromic features of R-CPD, inject the CPM with BT as a concurrent diagnostic and therapeutic maneuver, and assess results.

Setting: Bastian Voice Institute (Downers Grove, Illinois).

Subjects and methods: Consecutive (unselected) patients presenting with inability to belch and associated symptoms were matched to the proposed syndrome of R-CPD, treated with BT, and followed for effect on symptoms over time.

Results: All 51 patients achieved ability to belch and relief of associated symptoms, and the majority seem to have "retrained" the ability to belch on a potentially "permanent" basis.

Conclusion: R-CPD can be diagnosed syndromically, using a symptom complex; clinical diagnosis is validated by relief of symptoms after BT injection; and BT into the CPM is an efficacious treatment, whose benefit appears to often last longer than the pharmacologic duration of action of BT.

Keywords: belch; botulinum toxin; burp; cricopharyngeus; flatulence; upper esophageal sphincter.

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Figures

Figure 1.
Figure 1.
Prior tests and treatments that had not provided a diagnosis. CT, computed tomography; EGD, esophagogastroduodenoscopy; PPI, proton pump inhibitors.
Figure 2.
Figure 2.
Prevalence of symptoms associated with retrograde cricopharyngeus dysfunction: at diagnosis, 1 week after botulinum toxin, and at 6 months posttreatment. Percent based on denominator (number evaluable at each time point).
Figure 3.
Figure 3.
Intraoperative view of a botulinum toxin injection. Four locations in the cricopharyngeus bulge were injected. Here, we see (a) the right paramedian and (b) left paramedian. Deeper injections are not shown.
Figure 4.
Figure 4.
Abdominal film of a patient with retrograde cricopharyngeus dysfunction (R-CPD). While such a film by itself does not “make” the diagnosis of R-CPD as compared with “match” to the syndromic features, this film makes the nearly universal symptoms of feeling bloated, visible abdominal distention, and flatulence “visible.” Photo credit: Urgent Care 24/7–Midtown (Savannah, Georgia).
Figure 5.
Figure 5.
Patulous esophagus. The cricopharyngeus muscle (CPM) is being retracted posteriorly with a suction cannula (under arrow). As an unvalidated observation, the esophagus seen beyond the CPM typically appears to be abnormally open and even dilated.
See this image and copyright information in PMC

Comment in

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