The esophagus has two rings of muscle that allow the passage of food and liquid from the throat to the esophagus (swallowing pipe) and then into the stomach. These are called upper and lower esophageal sphincters. The upper esophageal sphincter is located at the top of the esophagus. This muscle is normally closed at rest and briefly relaxes briefly during swallowing to allow food and liquid to move from the throat into the esophagus. Cricopharyngeal dysfunction occurs when the CP muscle has difficulty relaxing during the swallow. This is typically seen in the elderly, patients who have undergone head and neck cancer treatment, and patients with neurologic conditions.

Cricopharyngeal Dysfunction Symptoms

Dysfunction of the CP muscle typically occurs gradually and symptoms progress over time. Patients endorse a “sticking” sensation with solid foods, pills, and/or liquids. They also feel like “things don’t go down” when they eat and drink.

Cricopharyngeal Dysfunction Diagnosis

A barium esophagram or modified barium swallow study (x-ray swallowing tests) allow clinicians to evaluate the function of the CP muscle. Food or liquid residue is seen in the throat after a patient swallows due to the incomplete passage of material through the upper esophageal sphincter. A test called an esophageal manometry can also be performed to measure the muscle contraction force and coordination along the entire esophagus during swallowing. 

Treatment for Cricopharyngeal Dysfunction

There are several options for treatment of CP muscle dysfunction. Botulinum toxin can be injected into the muscle to help it relax (cricopharyngeal botulinum toxin injection). This can allow better passage of food through the upper esophageal sphincter. This treatment may need to be repeated. The CP muscle can also be dilated (stretched) which this is generally done at the same time as botulinum toxin injection in the operating room. Cricopharyngeal myotomy is a surgery that can be performed to address CP muscle dysfunction. The CP muscle is cut to improve of the upper esophageal sphincter. The improvements after this surgery are typically immediate, especially for patients with severe CP dysfunction. 

Cricopharyngeal Bar

Cricopharyngeal Bar