The cricopharyngeal (CP) bar is an uncommon but important cause of oropharyngeal dysphagia (OPD). Treatment options include CP myotomy, which can be problematic, because CP bars primarily occur in elderly patients who are at higher risk for perioperative complications.
What causes a cricopharyngeal bar?
What causes cricopharyngeal bar? The cricopharyngeal (CP) bar can form from a thickening of the cricopharyngeus muscle caused by replacement of its muscle with fibrous connective. This is thought by many to be a reaction to chronic reflux of stomach contents into the esophagus.
What is cricopharyngeal dysfunction?
Cricopharyngeal dysfunction is relatively rare. It affects the muscle at the top of the throat called the cricopharyngeal muscle (CPM). This causes problems with the upper esophageal sphincter (UES). The UES is a valve at the top of the esophagus, or food pipe, which is the tube that connects the throat to the stomach.
What is the treatment for cricopharyngeal bars?
Treatment and prognosis. In selected patients with no other cause for dysphagia demonstrated, cricopharyngeal bars can be treated with a myotomy, esophageal dilatation and/or botulinum toxin injection 5,6.
Where is the cricopharyngeus muscle located?
The cricopharyngeus muscle is located at the bottom of the throat, between the throat and the esophagus. This muscle is normally contracted, preventing the reflux of foods from the esophagus into the throat. The cricopharyngeus muscle normally relaxes during swallowing, allowing food and liquids to pass easily from the throat into the esophagus.
What is CP bar?
Cricopharyngeal (CP) Bar is a ridge-like thickening of the back wall of the cricopharyngeal muscle seen on XR swallow testsas an indentation of the upper oesophagus. It is thought to be due to scarring and reduced stretch of the CP muscle. It can be an asymptomatic, incidental finding or it may cause dysphagia.
What can be done about a cricopharyngeal bar?
Purpose: Cricopharyngeal (CP) bar is an uncommon but important cause for dysphagia. It can be treated with surgical myotomy, however endoscopic dilation is a safe and effective option that is less invasive than surgery.
What is a cricopharyngeus bar?
What is cricopharyngeal bar? The cricopharyngeus muscle is located at the junction of the pharynx (throat) and esophagus, and is the major muscular component of what is called the upper esophageal sphincter (UES). At rest, the UES closes the passageway between the pharynx and esophagus.
What causes cricopharyngeal dysfunction?
Cricopharyngeal dysfunction can be caused by esophageal muscle enlargement, changes in the nerve signaling pathways, scarring of the muscle, radiation, trauma, stroke, or gastroesophageal reflux disease (GERD).
What may be some negative side effects of a cricopharyngeal myotomy?
Complications include (1) incomplete myotomy manifested as a persistent cricopharyngeal bar; (2) fistula or abscess formation; and (3) vocal cord paralysis due to recurrent laryngeal nerve damage.
Who diagnoses a CP bar?
A comprehensive evaluation by a laryngologist is essential to evaluating for Cricopharyngeal Hypertrophy. A videoflouroscopic swallow study (VFSS) performed by a speech pathologist is the best way to evaluate for a Cricopharyngeal bar.
How do you strengthen the Cricopharyngeal muscle?
You can also try these exercises for cricopharyngeal spasm: Shaker exercise: Lay down, raise your head and look at your feet without lifting your shoulders. Hold for 60 seconds, then repeat a few times. Mendelsohn maneuver: Hold your voice box for three to five seconds after swallowing.
Can the upper esophageal sphincter be repaired?
When this sphincter is not opening properly, there are several options for treatment, including injection of Botox to decrease tension of this muscle, dilation or stretching of the muscle with a bougie or a balloon, or cutting the muscle to weaken it endoscopically with a laser or via the neck through an incision in ...
What is the function of the cricopharyngeus muscle?
The cricopharyngeus is a narrow band of muscle strategically placed between the pharynx and esophagus. Its normal function is vital to the efficient transfer of foodstuffs to the esophagus. Cine- and videoradiography are the major methods of studying the pharyngo-esophageal segment.
How is cricopharyngeal dysfunction diagnosed?
Physicians typically diagnose cricopharyngeal dysfunction using high-resolution manometry with impedance.
What does a Cricopharyngeal spasm feel like?
Symptoms of Cricopharyngeal Spasm Individuals with cricopharyngeal spasm may describe a persistent sensation—usually felt precisely at the level of the cricoid cartilage—of something stuck in the throat, like a “wad of phlegm” or a “golf ball,” which the person cannot swallow or spit out.
Is cricopharyngeal myotomy safe?
Endoscopic cricopharyngeal myotomy is a safe and effective treatment option for patients with cricopharyngeus dysphasia.
Is cricopharyngeal myotomy safe?
Endoscopic cricopharyngeal myotomy is a safe and effective treatment option for patients with cricopharyngeus dysphasia.
How is upper esophageal sphincter dysfunction treated?
Treatments for upper esophageal sphincter dysfunction include botulinum toxin injection into cricopharyngeal muscle, UES dilation, endoscopic cricopharyngeal myotomy or transcervical cricopharyngeal myotomy.
How is Cricopharyngeal achalasia treated?
Current options for treatment include botulinum toxin injections, endoscopic balloon dilation, and open or endoscopic cricopharyngeal myotomy. All techniques have shown success in the treatment of the disease.
How is cricopharyngeal dysfunction diagnosed?
Physicians typically diagnose cricopharyngeal dysfunction using high-resolution manometry with impedance.
Nerve signaling pathway changes
The nerve signaling pathways that tell the CPM when to relax and contract can change, causing cricopharyngeal dysfunction.
Trauma, surgery, or radiation
Any process that causes scarring can lead to immediate or delayed cricopharyngeal dysfunction. For example, according to a 2020 study, cricopharyngeal dysfunction can occur years after surgery.
Stroke
Stroke can cause brain damage that impairs the ability to use the nerves controlling the upper esophageal sphincter.
Enlarged CPM
Cricopharyngeal dysfunction may occur in people if they have an enlarged, or prominent, CPM. This may be the result of the following:
Easing symptoms
Cricopharyngeal dysfunction will not go away with exercises or behavioral adjustments, and surgery may be the best option. However, some methods may help a person alleviate their symptoms.
Botox injections
Botulinum toxin, or Botox, injections can help relax or partially paralyze the upper esophageal sphincter.
Surgery
There are several ways to treat cricopharyngeal dysfunction surgically.
What Causes CPM Dysfunction?
CPM and UES dysfunction occur for varying reasons. It may result as a side effect of the normal aging process or due to changes in the CPM or nerve signaling pathways.
What Are the Treatment Options?
There are numerous treatment options that can substantially improve CPM dysfunction, including dilatation (stretching), oral medications, BOTOX® injection, and myotomy (cutting). Dilatation procedures are generally not permanent and allow for a trial period to see whether a treatment will be helpful.
Cricopharyngeal Achalasia Symptoms
Food is chewed but it goes round and round, and does not go down. feeling of bolus in throat, chocking, aspiration of food, weight loss may also occur. Feeling of food sticking in the throat or chest. Coughing is also a response due to different stimuli originating in the lungs, pharynx and larynx.
Cricopharyngeal Achalasia Causes
Cricopharyngeal spasm are caused by neurological conditions or due to damaging nerves causing stroke e.t.c. it can also be caused by muscular spasm of cricopharyngeus muscle or muscle dysfunction. This dysfunction or muscular spasm leads to dysphagia or cause difficulty in swallowing.
Cricopharyngeal Achalasia Treatment
Treatment of cricopharyngeal achalasia include muscle relaxants and also includes botilium toxin injection that injects in cricopharngeal muscle which is used as a trial of therapy, but the effect of botilium toxin injection is for short term relief. patients undergo repeated doses to maintain therapeutic effect.