Diagnosis and Management of Retrograde Cricopharyngeal Dysfunction: A Systematic Review.

Abstract

Objective: Retrograde cricopharyngeal dysfunction (R-CPD) is a syndrome with rapidly increasing awareness since being first described in March 2019. As such, few cases of R-CPD are currently reported in the literature. The goal of this study is to provide a comprehensive systematic review of the available literature on R-CPD, including patient characteristics, diagnosis, and management.

Data sources: PubMed, Scopus, EMBASE.

Review methods: A systematic review of the available English literature was conducted using the data sources PubMed, Scopus, and EMBASE. Studies with original data of patients experiencing classic symptoms of R-CPD were included. Independent abstract screening followed by full-text screening was performed to assess study eligibility. Data extraction of patient demographics, symptoms, treatment, and follow-up were subsequently performed.

Results: Common presentations of R-CPD include abelchia (100%), abdominal bloating (83%), and gurgling noises (75%). 554 (86.9%) patients had improved symptoms after initial treatment with BTX. The most common initial dose was 50 units in 204 (37.3%) patients. Subsequent BTX injections resolved symptoms in 40 (80%) patients. Six patients ultimately received CP myotomy for recurrent symptoms, resulting in long-term resolution in 4 (67%) patients.

Conclusion: R-CPD is a newly recognized syndrome with effective treatment options including botulinum toxin injections and cricopharyngeal myotomy, where appropriate. Diagnostic modalities including esophageal manometry may aid in the initial work up of R-CPD, however further studies are required to assess its diagnostic utility.