Cricopharyngeal Dysfunction

The esophagus, the muscular tube that connects the throat and stomach, has a sphincter near the top that controls the passage of food. This upper esophageal sphincter (UES)—also called the cricopharyngeus—is a semi-circular muscle below the Adam’s apple. To prevent the reflux of foods from the esophagus into the throat, the cricopharyngeus is usually shut tight. When a person swallows, it relaxes and allows food to pass.

In people with cricopharyngeal dysfunction, the muscle doesn’t relax, which blocks food from entering the esophagus and makes swallowing difficult. The problem can progress slowly. People with cricopharyngeal dysfunction may limit their diet to soft foods, and some may change their diet so drastically that they lose weight. Cricopharyngeal dysfunction is also called upper esophageal sphincter dysfunction or cricopharyngeal achalasia.

Symptoms of Cricopharyngeal Dysfunction

The symptoms of cricopharyngeal dysfunction may include the following:

• Difficulty swallowing, especially large pieces of food
• Feeling of food sticking in the throat
• Coughing when drinking or eating
• Needing to work harder to swallow

Causes of Cricopharyngeal Dysfunction

The causes of cricopharyngeal dysfunction may include normal aging or changes in nerve signaling pathways. This condition could also be caused by damage to the swallowing mechanism resulting from heartburn, stroke, or muscle scarring due to trauma or radiation therapy.

Diagnosing Cricopharyngeal Dysfunction

Your doctor has several ways to diagnose cricopharyngeal dysfunction. A visual examination of the back of your throat will often reveal a small amount of food or saliva pooled there.

These diagnostic tests may also be used:

• Esophageal manometry: This test measures how well the muscles in the esophagus work when you swallow. After the throat and nose are numbed, a thin, flexible tube (catheter) with sensors is passed through the nose, down the esophagus, and into the stomach. You will be asked to sip water during the test.
• Modified barium swallow study (MBS): During this test, you will be asked to swallow a variety of substances coated with barium. This whitish paste lights up during an x-ray. The test can show if the upper esophageal sphincter is not relaxing or if foods or liquids are blocked as they pass through the esophagus.

Treatments for Cricopharyngeal Dysfunction

If UES causes your swallowing problem, and the rest of your swallowing process is normal, treating that muscle will almost always help you return to normal swallowing. But if other parts of your swallowing mechanism are abnormal, treatment may be more complicated.

Cricopharyngeal dysfunction treatments include the following:

• Cricopharyngeus muscle myotomy: The definitive treatment for cricopharyngeal dysfunction is a procedure called cricopharyngeus muscle myotomy. In this procedure, a doctor cuts the UES to prevent it from over-tightening, so food is no longer blocked from the esophagus. This procedure can be performed through an incision made on the neck.
  More recently, endoscopic cricopharyngeal myotomy is becoming the treatment of choice at advanced centers. This minimally invasive procedure is performed by introducing a laser through the mouth. The newer endoscopic procedure offers patients a faster recovery and may be safer than traditional surgery.
• Botox injections: In some cases, cricopharyngeal dysfunction can be treated by temporarily paralyzing the UES with an injection of botulinum (Botox). This approach is not effective for every patient, and the injections need to be repeated every three to six months.
• Balloon dilation: This minimally invasive procedure is used to stretch the muscle and allow food and liquid to pass. This is performed with a catheter that is passed through the mouth and into the esophagus. A balloon at the end of the catheter is inflated to enlarge the opening. This procedure can significantly improve symptoms for about six months and may be repeated as needed.

Why Choose Columbia

Swallowing therapy specialists at Columbia’s Center for Voice and Swallowing offer the full range of treatments available for cricopharyngeal dysfunction. If diet or lifestyle changes don’t help manage your condition, our experts might suggest non-invasive options—such as Botox injections, acid reflux medications, or balloon dilation—before turning to surgery.