Pediatric otolaryngology fellow University of Utah
Introduction: Retrograde cricopharygeal dysfunction is a recently described disorder characterized by an inability to belch, abdominal or chest pressure, odd gurgling noises, and occasionally difficulty vomiting. Symptoms tend to worsen with carbonated beverages. Currently, the recommended treatment is botulinum toxin injections. Interestingly, the majority of patients reported benefit beyond the expected three-month duration of the botulinum toxin. Prior studies have included a few pediatric patients within larger datasets comprised primarily of adults. We describe our preliminary experience in pediatric patients, including presenting symptoms, treatment approach, and post-treatment outcomes.
Methods: Retrospective review of pediatric patients (aged <18 years) diagnosed with retrograde cricopharyngeal dysfunction. Medical records were reviewed for presenting symptoms, prior testing and treatment, details of treatment, and postoperative outcomes.
Results: Four patients with average age of 15.8±1.0 (2 females, 2 males) were included. Presenting symptoms included lifelong or nearly lifelong inability to burp (n=4), bloating (n=4), awkward gurgling noises (n=2), and worsening of symptoms with carbonated beverages (n=4). One patient had prior normal upper endoscopy. Two patients underwent cricopharyngeal botulinum toxin injections with two more planning to do so. Via direct microlaryngoscopy under brief general anesthesia, 50 units of botulinum toxin were injected to the posterior cricopharyngeus across four locations. Both patients had resolution of symptoms without recurrence at five-month follow-up.
Conclusion: Retrograde cricopharyngeal dysfunction may be an underdiagnosed condition. Now that there is a diagnosis, we will likely see more adult and pediatric patients with these symptoms. Adolescent patients may respond similarly to adults. Larger studies with longer-term follow-up are needed to characterize disease presentation and treatment outcomes.