Retrograde cricopharyngeus dysfunction: what the gastroenterologist should know

PURPOSE OF REVIEW: To review current literature about retrograde cricopharyngeus dysfunction (R-CPD) etiology, pathophysiology, clinical presentation and management. RECENT FINDINGS: R-CPD is a clinical condition characterized by inability to burp that is often associated with a variety of other gastrointestinal symptoms. Limited data suggest that R-CPD may affect up to 22% of the general population, with 13% experiencing severely troublesome symptoms. Symptoms usually begin in childhood, though diagnosis typically occurs many years later after prolonged symptom burden. Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) are strongly associated with R-CPD, with prevalence rates ranging from 28 to 58% across studies, suggesting either that GERD and LPRD contribute to the development of R-CPD or vice versa , with R-CPD producing prolonged elevations in esophageal pressure and esophageal stretching that contribute to the development of GERD and LPRD. Family history is present in 28% of cases, suggesting possible genetic predisposition. Botulinum toxin injection (BTI) into the cricopharyngeal sphincter represents the primary therapeutic option, achieving up to 92.5% overall initial success rate using various approaches, including in-office transcervical (EMG-guided), transnasal, and operating room esophagoscopy techniques. Younger age, higher botulinum toxin doses, and operative esophagoscopy under general anesthesia have been associated with better treatment outcomes. Symptom recurrence occurs in 4-45% of patients, with mean recurrence intervals between 6 and 8 months. SUMMARY: R-CPD represents an underrecognized but potentially common condition with significant impact on quality-of-life. BTI demonstrates high efficacy with an acceptable safety profile. Standardized diagnostic criteria, treatment protocols, and comprehensive pediatric studies for R-CPD remain sorely needed.