Prospective Evaluation of Abelchia/RCPD Patients: Abnormalities in High-Resolution Esophageal Manometry.

Self-diagnosis of retrograde cricopharyngeus dysfunction (RCPD) or abelchia has been increasing over the past 5 years with patients seeking treatment for lifelong symptoms of inability to burp, neck gurgling, bloating, and flatulence. There is a distinct paucity of objective data in diagnosis and underlying pathophysiology of this disorder.

Objective: The purpose of this study was to prospectively evaluate patients with abelchia using standardized investigations to explore possible underlying mechanisms.

Methods: Patients presenting with clinical scenario consistent with RCPD were recruited into the study after informed consent. All patients underwent standardized investigations: Self reporting questionnaires EAT-10, VHI-10, and RSI scores, as well as esophagogastroscopy, barium swallow, and high-resolution esophageal manometry (HRM), were performed.

Results: RCPD patients demonstrated a minor increase in the mean EAT-10 (5.2 ± 1.2) and normal RSI/VHI-10 scores. Barium swallow revealed 53% (CI 38%-64%) were abnormal with reflux with hiatus hernia (37%) and dysmotility (16%) as most common findings. HRM showed that 67% (CI 54%-78%) were abnormal. Ineffective motility was found in 41%, a further 23% showed a complete absence of peristalsis, whereas 33% were normal.

Conclusions: RCPD is a clinical condition of lifelong inability to belch and associated symptoms. The underlying pathophysiology is poorly understood. This study demonstrates that a significant number of RCPD patients have abnormal esophageal neural network with high proportion of abnormal or absent esophageal peristalsis.

Level of evidence: 3 Laryngoscope, 2024.