University of Utah, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, United States; University of Iowa, Department of Otolaryngology-Head and Neck Surgery, United States.
University of Utah, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, United States.
Int J Pediatr Otorhinolaryngol. 2022 Oct;161:111261. doi: 10.1016/j.ijporl.2022.111261. Epub 2022 Aug 4.
Retrograde cricopharyngeal dysfunction was recently described by Bastian in 2019 and is characterized by an inability to belch, abdominal or chest pressure, odd gurgling noises, and occasional difficulty vomiting. Symptoms tend to worsen with carbonated beverages. Currently, the recommended treatment is cricopharyngeus muscle botulinum toxin injections. Prior studies have included few pediatric patients within larger datasets comprised primarily of adults. We describe our preliminary experience in pediatric patients, including presenting symptoms, treatment approach, and post-treatment outcomes.
Retrospective chart review of pediatric patients (aged <18 years) diagnosed with retrograde cricopharyngeal dysfunction based on clinical history by the senior author. Medical records were reviewed for presenting symptoms, prior testing and treatment, details of treatment, and postoperative outcomes.
Five patients with average age of 14 ± 4 (3 females, 2 males) were included. Presenting symptoms included lifelong or nearly lifelong inability to burp (n = 5), bloating (n = 5), awkward gurgling noises (n = 3), and worsening of symptoms with carbonated beverages (n = 5). Two patients had prior normal upper endoscopy. All patients underwent cricopharyngeal botulinum toxin injection under general anesthesia, with 25-50 units of botulinum toxin injected to the posterior cricopharyngeus across 4-5 locations. All patients had resolution of symptoms with follow-up of 1.5-10 months.
Retrograde cricopharyngeal dysfunction may be underdiagnosed due to lack of awareness of the condition. Now that the phenomenon of inability to belch has a name and is being reported in the literature, we will likely see more adult and pediatric patients with these symptoms. Pediatric patients may respond similarly to adults. Larger studies with longer-term follow-up and targeted patient-reported outcome measures are needed to characterize disease presentation and treatment outcomes.
逆行环咽肌功能障碍是由 Bastian 于 2019 年最近描述的，其特征是无法打嗝、腹部或胸部有压迫感、发出奇怪的汩汩声，偶尔呕吐困难。症状往往会随着碳酸饮料的摄入而加重。目前，推荐的治疗方法是环咽肌肉毒毒素注射。先前的研究包括在主要由成年人组成的更大数据集内纳入了少数儿科患者。我们描述了我们在儿科患者中的初步经验，包括临床表现、治疗方法和治疗后结果。
对被高级作者根据临床病史诊断为逆行环咽肌功能障碍的儿科患者（年龄<18 岁）进行回顾性图表审查。回顾了病历以了解临床表现、既往检查和治疗、治疗细节以及术后结果。
纳入了 5 名平均年龄 14±4 岁的患者（3 名女性，2 名男性）。主要临床表现包括终生或几乎终生无法打嗝（n=5）、腹胀（n=5）、尴尬的汩汩声（n=3）以及碳酸饮料摄入后症状加重（n=5）。有 2 名患者之前有正常的上消化道内镜检查。所有患者均在全身麻醉下接受环咽肌肉毒毒素注射，在 4-5 个部位向环咽肌后注射 25-50 个单位的肉毒毒素。所有患者在随访 1.5-10 个月后症状均得到缓解。
由于对这种疾病缺乏认识，逆行环咽肌功能障碍可能被漏诊。既然无法打嗝的现象有了名字并在文献中得到报道，我们可能会看到更多有这些症状的成人和儿科患者。儿科患者的反应可能与成人相似。需要进行更大规模的研究，进行更长期的随访和针对患者报告的结果测量，以确定疾病表现和治疗结果。
