Retrograde cricopharyngeal dysfunction: 5 years on, what is the evidence, who are the failures?

PURPOSE OF REVIEW: Awareness of retrograde cricopharyngeal dysfunction (RCPD) has accelerated substantially in the last 5 years, amongst both physicians and patients, especially with growing patient communities on social media. As the volume of research has grown rapidly, this review provides a timely synthesis of current evidence on diagnosis, treatment, and in particular, treatment failure, an area that remains underexplored despite its importance to clinical decision-making. RECENT FINDINGS: RCPD lacks a validated diagnostic test; high-resolution impedance manometry offers pathophysiological insight but has yet to yield normative diagnostic thresholds. Injection of botulinum toxin-A (BoNT-A) into the cricopharyngeus muscle remains first-line treatment, delivered either transorally in the operating theatre or percutaneously in-office, with comparable efficacy but differing doses and side-effect profiles. Reported success rates are high but heterogeneous, reflecting variable outcome definitions. Evidence on managing treatment failures - including repeat injection, dose escalation, and surgical salvage - remains sparse and largely anecdotal. SUMMARY: Standardized diagnostic criteria and outcome measures are needed to enable meaningful cross-study comparison and evidence-based management of RCPD, particularly for patients who fail first-line BoNT-A therapy. Realistic pretreatment counselling and wider publication of treatment failures are recommended to strengthen the evidence.