Operating Room or In Office for RCPD Botulinum Toxin Injection

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BACKGROUND

Retrograde cricopharyngeal dysfunction (RCPD), commonly known as “no burp syndrome,” is characterized by an inability to burp. Symptoms include bloating, gurgling sounds, chest and abdominal discomfort, and excessive flatulence, all contributing to a reduced quality of life.

The cricopharyngeus muscle relaxes during swallowing and burping to allow for the release of air. In patients with RCPD, relaxation during burping does not occur effectively, leading to the aforementioned symptoms. Although the etiology of RCPD remains unclear, one hypothesis is that abnormalities in the nerve signals controlling the upper esophageal sphincter (UES) result in inadequate muscle relaxation. Anxiety and stress may exacerbate symptoms by influencing muscle tension. Literature suggests that RCPD has a higher prevalence among younger, female patients and in individuals with underlying anxiety disorders or other neuromuscular conditions.

RCPD is a clinical diagnosis made following a comprehensive history and physical examination. Botulinum toxin injection to chemically denervate the cricopharyngeus muscle has been proposed as both diagnostic and therapeutic for this disorder. Botulinum toxin injection can be performed in the operating room or in office, with specific risks and benefits to each driving physician and patient preference.

Best Practice

The current literature demonstrates that RCPD can be effectively treated in the majority of patients with botulinum toxin injection into the cricopharyngeus muscle. The procedure is similarly successful when performed in the operating room or in the office, but the two approaches have different side effect profiles. Surgeons comfortable with both strategies should involve their patients in the decision-making process by discussing the relative risks and benefits of each, allowing for a more personalized treatment approach.