INTRODUCTION Complete inability to belch due to retrograde cricopharyngeus dysfunction (R-CPD) may lead to chronic gas-related gastrointestinal complaints. We aimed to validate high-resolution manometric (HRM) diagnostic criteria and prospectively evaluate the feasibility and efficacy of cricopharyngeal botulinum toxin injection (CBTI) by flexible endoscopy. METHODS Consecutive manometrically diagnosed patients with R-CPD were included. Asymptomatic volunteers were also included for diagnostic validation. Patients with R-CPD underwent CBTI (treatment group) or deferred/declined treatment (control group). Outcomes included ability to belch, clinical symptoms, and quality of life measured using self-report questionnaires. RESULTS Sixty-five subjects were included (52 treatment group, 7 controls, and 6 asymptomatic volunteers). All patients with R-CPD had inability to belch since childhood. During HRM with carbonated drink provocative testing, all R-CPD patients demonstrated characteristic esophageal pressurization patterns associated with failure of upper esophageal sphincter relaxation; these findings were never seen in asymptomatic volunteers. At 3 months, 92% patients who received CBTI were able to belch (compared with 0 controls; P < 0.001) and experienced improved clinical symptoms (global symptom score improved from 7.3 ± 1.7 to 1.8 ± 2.3, whereas in controls was static 7.5 ± 2.1 to 7.7 ± 1.8; P < 0.0001 for comparison). Quality of life significantly improved in the treatment group but not controls ( P = 0.0002). At 3 months, 43/51 (84%) of the treatment group reported being satisfied or very satisfied with therapeutic outcome. DISCUSSION HRM with carbonated drink provocation demonstrates pathognomonic signs of R-CPD that were not seen in health. Flexible endoscopic CBTI is highly effective for symptomatic relief compared with no treatment.

中文翻译：

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内窥镜下肉毒杆菌毒素注射治疗逆行性咽咽功能障碍的前瞻性对照研究：无法打嗝综合征。


引言 由于逆行环咽功能障碍 （R-CPD） 而完全无法打嗝可能导致慢性气体相关的胃肠道不适。我们旨在验证高分辨率测压 （HRM） 诊断标准，并前瞻性评价软式内窥镜环咽肉毒杆菌毒素注射 （CBTI） 的可行性和有效性。方法 纳入连续测压诊断的 R-CPD 患者。无症状志愿者也被纳入诊断验证。R-CPD 患者接受 CBTI （治疗组） 或延迟/拒绝治疗 （对照组）。结局包括打嗝能力、临床症状和使用自我报告问卷测量的生活质量。结果 共纳入 65 例受试者 （52 例治疗组、7 例对照组和 6 例无症状志愿者）。所有 R-CPD 患者从儿童时期起就无法打嗝。在碳酸饮料激发试验的 HRM 期间，所有 R-CPD 患者都表现出与食管上括约肌松弛失败相关的特征性食管加压模式;这些发现从未在无症状志愿者中发现。在 3 个月时，92% 接受 CBTI 的患者能够打嗝（相比之下，对照组为 0;P < 0.001）并出现临床症状改善（总体症状评分从 7.3 ± 1.7 提高到 1.8 ± 2.3，而对照组为静态 7.5 ± 2.1 提高到 7.7 ± 1.8;P < 0.0001 进行比较）。治疗组的生活质量显着改善，但对照组没有 （P = 0.0002）。3 个月时，治疗组中有 43/51 （84%） 报告对治疗结果满意或非常满意。讨论 碳酸饮料激发 HRM 显示 R-CPD 的特异性体征，这些体征在健康中未见。 与不治疗相比，软式内窥镜 CBTI 对缓解症状非常有效。