Retrograde cricopharyngeal dysfunction management with botulinum toxin A.

Introduction: Retrograde cricopharyngeal dysfunction (R-CPD) is the inability to belch due to impaired upper oesophageal sphincter relaxation. Botulinum toxin A injection shows promise, but standardised protocols are lacking.

Objective: To evaluate the effect of botulinum toxin A for R-CPD in a Danish population.

Methods: A retrospective case series study at Aarhus University Hospital included R-CPD patients treated from January 2021 to December 2024. The diagnosis was clinical, supported by otorhinolaryngological examination, modified barium swallow and oesophagoscopy. Under general anaesthesia, all patients received 50 IU of botulinum toxin A into the cricopharyngeal muscle. Symptom relief and adverse effects were assessed at follow-ups performed at two weeks and three months. Statistical analysis with Fisher's exact test compared treatment responses in patients aged 18-25 years versus those over 25 years.

Results: Among 40 patients (22 males, 18 females, mean age 27.5 years), 35 experienced symptom relief within two weeks. Long-term follow-up (31 patients) showed that 18 continued to belch after three months. Thirteen patients required additional treatments with botulinum toxin A doses increased to 75-100 IU, 24 achieved satisfactory results, while nine await further procedures.

Conclusions: Botulinum toxin A is a safe, effective R-CPD treatment with minor side effects (transient dysphagia, mild sore throat, sour eructation) and no vocal fold or respiratory complications. Over half of the patients improved after 50 IU treatment, whereas one-third required dose escalation, suggesting that 100 IU may enhance outcomes.

Funding: None.

Trial registration: Not relevant.