Abstract
BackgroundCricopharyngeus muscle dysfunction (CPMD) is a common cause of dysphagia. We employ a progressive series of three double-balloon dilations separated by 4–6 weeks between procedures as a primary treatment option. The purpose of this study was to evaluate subjective, functional and objective improvement in swallowing after three serial dilations for CPMD.MethodsWe retrospectively evaluated patients between June 1, 2014, and June 30, 2016, who underwent a series of three double-balloon dilations for CPMD. Pre- and post-dilation Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), pharyngeal constriction ratio, pharyngeal area, and pharyngoesophageal segment (PES) opening were compared.ResultsSeventeen patients with CPMD underwent serial double-balloon dilation procedures separated by one month. Mean age of the cohort was 73.5 (SD ± 13.3) years, and 53% were female. The mean EAT-10 improved from 24.7 (SD ± 7.8) to 15.9 (SD ± 10.2) [p = 0.0021]. Mean FOIS improved from 5.4 (SD ± 1.4) pre- to 6.3 (SD ± 0.9) post-treatment (p = 0.017). Mean UES opening increased from 1.05 (SD ± 0.34) cm to 1.48 (SD ± 0.41) cm (p = 0.0003) in the anteroposterior fluoroscopic view and from 0.58 (SD ± 0.18) to 0.76 (SD ± 0.30) cm (p = 0.018) in the lateral view. Pharyngeal constriction ratio (PCR), a surrogate measure of pharyngeal strength, improved from 0.49 (SD ± 0.37) to 0.24 (SD ± 0.15) (p = 0.015), however pharyngeal area (PA) was unchanged.ConclusionsA progressive series of three double-balloon dilations for cricopharyngeus muscle dysfunction resulted in improved patient reported dysphagia symptom scores and objective fluoroscopic swallowing parameters.
Highlights
Cricopharyngeus muscle dysfunction (CPMD) is a common cause of dysphagia
CPMD manifests as a spectrum of videofluoroscopic swallowing study (VFSS) findings ranging from non-obstructing bars found in up to 30% of the asymptomatic population to severely obstructing bars that limit oral intake to solids and liquids (Fig. 1) [9]
We identified ten patients (59%) who underwent additional upper esophageal procedures, nine of whom had repeat dilations and one who opted for a cricopharyngeus myotomy
Summary
Cricopharyngeus muscle dysfunction (CPMD) is a common cause of dysphagia. We employ a progressive series of three double-balloon dilations separated by 4–6 weeks between procedures as a primary treatment option. The purpose of this study was to evaluate subjective, functional and objective improvement in swallowing after three serial dilations for CPMD. Oropharyngeal swallowing dysfunction is common and costly. One of the most common causes of solid food oropharyngeal dysphagia is cricopharyngeus muscle dysfunction (CPMD) [8]. CPMD manifests as a spectrum of videofluoroscopic swallowing study (VFSS) findings ranging from non-obstructing bars found in up to 30% of the asymptomatic population to severely obstructing bars that limit oral intake to solids and liquids (Fig. 1) [9]. Treatment options include diet modification, botulinum toxin injection, dilation and endoscopic or open myotomy [7]. The optimal treatment requires an individualized strategy that takes into account disease severity, patient comorbidities and functional status, prognosis and required duration of effect
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