HCA Shard London, BMI Blackheath, London & Alexandra Hospital, Manchester, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
Eur Arch Otorhinolaryngol. 2021 Dec;278(12):5087-5091. doi: 10.1007/s00405-021-06790-w. Epub 2021 Apr 24.
This is retrospective case series involving 72 patients who presented with symptoms associated with inability to burp. The following symptoms was described by almost all the patients; retrosternal pain after eating or drinking, bloating feeling in the stomach, gurgling noise in the throat, excessive flatulence. These symptoms are worse with fizzy/carbonated drinks and beer. A full clinical history and examination plus endoscopic and in some cases barium a swallow radiological investigation was done.
The surgery was performed under a general anaesthesia for all cases. Suspension pharyngoscopy in supine position using a Weerda diverticuloscope to identify the cricopharyngeal bar muscle. High dose of botulinum toxin A (botox) 100 iu was injected into the cricopharynxgeus muscle under a general anaesthesia.
A total of 72 patients were diagnosed and undergone surgery between November 2016 and December 2020. There were 50 male and 22 female patients. Their average age was 30 (range 18-68 years old). All patients were able to burp again within first 4 weeks of the injection. This persisted even after the Botox worn off beyond the 3 months in 96% of cases. The average follow-up was 24 months post injection with longest follow-up 48 months (range 1-48 months).
The author reported a new condition of inability to burp due to failure of the cricopharyngeal sphincter to relax spontaneously and outcome of treatment using botulinum toxin A injection into the cricopharyngeus muscle. It is expected that the paralysing action of botulinum toxin injection last approximately 3 months. However, this group of patients seem to be cured even after the effect of the botox is worn off. The author therefore postulated that there might me some neural dysfunction that inhibits the brain to send signals to the cricopharyngeal sphincter to initiate burping. Once burping is re-established with the help of botox injection, spontaneous burping seems to occur and sustained even after the botox is worn off.
这是一项回顾性病例系列研究，涉及 72 名出现呃逆困难相关症状的患者。几乎所有患者都描述了以下症状：进食或饮水后胸骨后疼痛、胃部饱胀感、喉咙咕噜咕噜作响、过度嗳气。这些症状在饮用碳酸饮料和啤酒时更为严重。对所有患者均进行了详细的临床病史和体格检查，以及内镜检查，部分患者还进行了钡餐吞咽放射学检查。
所有病例均在全身麻醉下进行手术。仰卧位时使用 Weerda 憩室镜行悬雍垂喉镜检查，以识别环咽肌。在全身麻醉下，将高剂量的肉毒杆菌毒素 A（肉毒杆菌毒素）100 国际单位注入环咽肌。
2016 年 11 月至 2020 年 12 月期间共诊断并手术治疗了 72 例患者。其中男 50 例，女 22 例。平均年龄为 30 岁（范围 18-68 岁）。所有患者在注射后 4 周内均能再次呃逆。在 96%的病例中，肉毒杆菌毒素的作用在 3 个月后消退超过 3 个月后仍能持续。平均随访时间为注射后 24 个月，最长随访时间为 48 个月（范围 1-48 个月）。
作者报告了一种新的呃逆不能的疾病，其原因是环咽肌不能自发松弛，并通过向环咽肌注射肉毒杆菌毒素 A 来治疗这种疾病。预计肉毒杆菌毒素的麻痹作用持续约 3 个月。然而，这组患者似乎在肉毒杆菌毒素的作用消退后也得到了治愈。因此，作者推测可能存在一些神经功能障碍，阻止大脑向环咽肌发送启动呃逆的信号。一旦在肉毒杆菌毒素注射的帮助下恢复呃逆，自发呃逆似乎会发生，并在肉毒杆菌毒素消退后持续存在。
