Retrograde Cricopharyngeus Dysfunction effectively treated with low dose botulinum toxin. A case report from Italy

Pavesi, L.; Balzano, Cecilia; Mauramati, Simone; Giudice, Carla; Fresia, Mauro; Todisco, Massimiliano; Alfonsi, Enrico; Cosentino, Giuseppe

doi:10.3389/fneur.2023.1238304

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…After receiving the botulinum toxin injection, research has demonstrated a substantial improvement in the quality of life for patients, with a patient even describing their response to the injection as “life changing.” 7 In a different patient's R‐CPD treatment with Botox, their quality‐of‐life score surged from 30, recorded just before the injection, to 100 during follow‐ups at 1, 2, 3, and 4 months. This highlights the significant impact that the incapacity to belch can exert on patients, underscoring the positive transformative outcomes that treatment can induce 14 . Both our investigation and previous studies underscore the profound effects the inability to burp can have on individuals, emphasizing the extensive and far‐reaching consequences it can entail.…”

Section: Discussionsupporting

confidence: 59%

Retrograde cricopharyngeus dysfunction: How does the inability to burp affect daily life?

Chen,

Evans,

Fakhreddine

et al. 2023

Neurogastroenterology Motil

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BackgroundRetrograde cricopharyngeus dysfunction (R‐CPD), a condition first detailed in 1987 and termed in 2019, refers to the cricopharyngeal muscle's inability to relax to allow the retrograde passage of gas. Limited research exists on the fundamental characteristics of this condition, including its impact on one's life. The purpose of this study is to characterize R‐CPD and how the inability to burp affects the social lives of people who suffer from it.MethodsA Qualtrics survey was distributed on the subreddit “r/noburp,” a community of 26,000 individuals sharing information about R‐CPD. Adults aged 18–89 experiencing R‐CPD symptoms were invited to participate. Participants reported on their experiences with R‐CPD and its effects on social life on a 4‐point Likert scale (1 = strongly disagree to 4 = strongly agree). Data was analyzed using descriptive statistics.Key ResultsAmong the 199 respondents, the mean age was 30.9, and gender identity was 74%/25% female/male. 99% reported inability to burp, 98% reported abdominal bloating, 93% reported socially awkward gurgling noises, 89% reported excessive flatulence, and 55% reported difficulty vomiting. Only half discussed their symptoms with their primary care provider (PCP), and 90% disagreed with receiving adequate help. Average Likert scores indicated embarrassment (3.4), anxiety/depression (3.1), negative impact on relationships (2.6), and work disruption (2.7) due to R‐CPD.Conclusions & InferencesR‐CPD is unfamiliar to many healthcare providers, leaving patients underserved. It not only affects daily life but also personal and professional relationships. Raising awareness by understanding disease basic features may increase diagnosis and treatment rates, improving quality of life.

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Section: Discussionsupporting

confidence: 59%

Retrograde cricopharyngeus dysfunction: How does the inability to burp affect daily life?

Chen,

Evans,

Fakhreddine

et al. 2023

Neurogastroenterology Motil

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“…Reported success rates vary from 88.2-95% with a preferred dose of botulinum toxin, which varies from 25U-100U [7,8,22,23,27]. Recently, a case report performed by Pavesi et al discussed a patient with RCPD who was treated with 10U of botulinum toxin with a durable response at 4 months of clinical follow-up [28]. No studies have identified particular patient characteristics that are associated with the success of initial treatment with botulinum toxin, and further, it is not known what the standard dose of botulinum toxin should be for treatment of RCPD.…”

Section: Botulinum Toxin Injections Into the Cricopharyngeus Musclementioning

confidence: 99%

Retrograde Cricopharyngeal Dysfunction: A Review

Miller,

Lina,

Akst

2024

JCM

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Retrograde cricopharyngeal dysfunction (RCPD), also referred to as retrograde cricopharyngeus dysfunction, is a condition characterized by the inability to burp. The pathophysiology of this condition is thought to result from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension, which leads to patients’ bothersome symptoms. RCPD negatively impacts patients’ quality of life and is associated with bloating, gurgling, avoidance of carbonation, self-imposed dietary and lifestyle changes designed to minimize discomfort, and flatulence. Complaints often start during adolescence, and many patients search for a diagnosis for years before obtaining treatment. A recent increase in awareness through patient-led social media discussion boards describing the ’no burp‘ syndrome is leading to an increasing incidence of presentations, often with patients making a self-diagnosis. The increased incidence of RCPD is fueling a larger case series investigating treatment options and outcomes. In this review, we discuss what is known about the pathophysiology of this condition, the otolaryngologic perspective on diagnosis and treatment, the patients’ lived experience of this condition, and the influence of social media on RCPD.

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“…[16] reported on the first case of inability to belch syndrome diagnosed in Italy. The 28-year-old patient was treated with percutaneous injection of only 10 U of onabotulinum toxin-A [17].…”

Section: Recent Publications On Inability To Belch Syndromementioning

confidence: 99%

Inability to belch syndrome: what the gastroenterologist needs to know

Smout,

Bredenoord,

Oude Nijhuis

2024

Current Opinion in Gastroenterology

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Purpose of review To review recent publications on the inability to belch syndrome. Recent findings Five recent retrospective case series indicate that the inability to belch syndrome usually starts in early childhood and is often accompanied by gurgling noises in the chest, pain in the chest or upper abdomen, bloating, and excessive flatulence. Currently, the vast majority of patients who have been identified with inability to belch have self-diagnosed the syndrome on the basis of information available on the internet. A favorable response to injection of botulinum toxin in the cricopharyngeus muscle is regarded as confirmation of the diagnosis. In a mechanistic study in eight patients, absence of reflexogenic relaxation of the upper esophageal sphincter upon rapid gaseous esophageal distension was confirmed to play a pivotal role in the pathogenesis of the syndrome. Summary The inability to belch syndrome, caused by failure of the upper esophageal sphincter to relax when the esophageal body is distended, clearly exists and may not be as rare as thought hitherto. However, overdiagnosis is also likely to occur because the diagnosis is usually made on the basis of symptoms only. The efficacy of botulinum toxin injection in the upper sphincter needs to be assessed in double-blind placebo-controlled studies.

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Retrograde Cricopharyngeus Dysfunction effectively treated with low dose botulinum toxin. A case report from Italy

Cited by 5 publications

References 19 publications

Retrograde cricopharyngeus dysfunction: How does the inability to burp affect daily life?

Retrograde cricopharyngeus dysfunction: How does the inability to burp affect daily life?

Retrograde Cricopharyngeal Dysfunction: A Review

Inability to belch syndrome: what the gastroenterologist needs to know

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