A wide esophagus due to trapped air. This is common in R-CPD and causes chest pains, gurgles and other symptoms.This was done using an ENT scope without insufflated air.
Retrograde cricopharyngeus dysfunction (R-CPD) is a
Some with the condition are also unable to vomit, or can only do so with great difficulty. It is a lifelong problem that is usually first noted in adolescence, but has also been reported as early as infancy. Most people with this condition also complain of frequent bloating, "gurgling noises" from the throat, frequent flatulence and poor tolerance to carbonated beverages. Many sufferers experience noticeable abdominal distension, with men and women alike saying they look "six months pregnant" by the end of the day. As air is released through the night, the abdomen will assume a more normal appearance by morning.
The
upper esophageal sphincter. It is a circular muscle at the base of the throat, behind the larynx. The muscle is closed (actively contracting) at all times and opens for swallowing or to allow relief of pressure in the esophagus via burping or vomiting
. In R-CPD, the swallowing function of the muscle is normal but the response to pressure in the esophagus is absent.
Diagnosis of R-CPD is achieved primarily through a positive match of telltale symptoms. Many patients finally get an accurate diagnosis of R-CPD after having been subjected to years of testing for, and unsuccessful treatment of, gastronomical disorders like GERD, aerophagia, gallbladder dysfunction, and IBS.
Treatments
The initial treatment of R-CPD is injection of
botox
into the cricopharyngeus muscle. botox will temporarily weaken or paralyze the muscle. The direct effects of botox last for three months on average. For most patients with R-CPD, injection of botox into the cricopharyngeus muscle will reverse the symptoms, and for many, the effect will last beyond the first three months. 30% of patients describe some swallowing difficulty after the injection that usually resolves after the first 3-4 weeks.
The first treatment is usually performed under
general anesthesia. The procedure lasts 15-20 minutes and results in a mild sore throat. The effect of botox is delayed for three days on average and most patients with successful results report the ability to burp by the fifth day after the procedure. Subsequent injections can be considered and administered with local anesthesia.[2]
A study from 2022 showed 88.2% efficacy of the botox treatment. The most common side effect in the study was mild and temporary difficulty swallowing, which went away on its own. This affected 30.6% of the participants.[4]
A small percentage of patients will require a subsequent injection of Botox for lasting results.
