Retrograde Cricopharyngeal Dysfunction

The procedure is considered very successful. 99.5% of people are reported to be able to burp following the injection and 95% experience significant symptom relief.

R-CPD diagnosis is mainly based on symptoms and patient history. The treatment is often considered both diagnostic and therapeutic.

Uniqly to Mr Al Yaghchi practice, he offers a carbonated water provocation dignostic test using pharyngeal high-resolution manometry (Ph-HRM). This test is often reserved for difficult cases, unclear diagnosis or those who fail to respond to treatment. However the test can be offered, if desired, to confirm diagnosis to other patients.

The typical symptoms of R-CPD are as follows:

1. Inability to burp
2. A gurgling sound in the chest
3. Bloating and tummy fullness
4. Excess flatulence.

These symptoms are often present in early adolescence and the diagnosis is often missed for many years.

Awareness of R-CPD has predominantly spread recently through the work of specialists and patient groups. As such, diagnosis can be challenging. If you present symptoms resembling R-CPD, we are open to a conversation discussing your options and whether you would benefit from treatment.

he treatment is administered either endoscopically via the mouth under short general anaesthesia or via the skin at the front of the neck in the clinic. For the latter we use an electromyography (EMG) device to help confirm the position of the needle within the cricopharyngeus muscle.

R-CPD treatment is not currently funded by the NHS

The most common side effect of the treatment is temporary swallowing difficulty which typically lasts around two to three weeks. Another rare side effect is temporary weakness of the vocal cord movement, as one of the muscles responsible for opening the vocal cords (PCA) lies in close proximity to the CP muscle. Nevertheless, side effects are temporary and improve within a few weeks.

Research suggests that the results are permanent for around 80% of recipients following a single injection. Others might require a second intervention with a higher dose, and very rarely regular injections might be needed.

The procedure is done as a day case and only takes minutes to administer. If performed in the operating room, the time of general anaesthesia and recovery are added, with a total stay in hospital of around three hours.

The cost will differ depending on whether it is performed ”in-office” or in the operating room. Please enquire via secretary@lvsclinic.com for a specific quote.

The effects will begin around five days after the treatment and symptoms will continue to improve gradually over three to four weeks.

For many patients, a single injection is sufficient. Through follow up appointments, the option of a second injection with a higher dose can be discussed for the minority of patients who still show symptoms after six months.

No, the muscle will be temporarily paralysed until the effects of the Botox wear off, which can take around three months. However relief from R-CPD symptoms often outlasts the effect of Botox and is permanent in the majority of patients. The mechanism of the long-term effect is not fully known. One theory suggests that the Botox injection allows the CP muscle to retrain and that the patient relearns how to burp.

Temporary swallowing difficulty (dysphagia) after treatment is a common side effect. This is caused by the temporary weakness of the swallowing muscles in the first few weeks after injection. The severity of these symptoms varies and are mild in the majority of cases. Patients might experience difficulty swallowing large bites of foods with a chewier consistency, such as meat. Smaller bites and softer consistencies are recommended if a patient is experiencing dysphagia after treatment. Regurgitation is a much rarer side effect and describes the occasional return of a small amount of food and drink from the oesophagous into the throat. If this does occur, it can be effectively managed by eating smaller meals and avoiding lying down straight after eating until the effects of the Botox starts to wear off. Both side effects are temporary.