Cricopharyngeal Achalasia: Symptoms and Treatments

Cricopharyngeal achalasia is a rare and often misunderstood condition that affects the upper esophageal sphincter (UES), resulting in swallowing difficulties. As a pivotal component of the digestive tract, the UES plays a crucial role in enabling the passage of food from the throat to the esophagus. 

In individuals with cricopharyngeal achalasia, this process is impaired, leading to a range of symptoms and complications.

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Causes of Cricopharyngeal Achalasia

The exact cause of cricopharyngeal achalasia remains unclear, though several factors may contribute to its development.

Neuromuscular Disorders

Neuromuscular disorders such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), or myasthenia gravis may affect the function of the cricopharyngeal muscle, leading to achalasia.

Aging

As individuals age, the muscles of the throat may weaken, resulting in diminished function of the UES and predisposing them to cricopharyngeal achalasia.

Structural Abnormalities

Anatomical abnormalities, such as a cricopharyngeal bar or diverticulum, can obstruct the normal functioning of the UES and contribute to swallowing difficulties.

Idiopathic Causes

In some cases, no identifiable cause is found, and the condition is deemed idiopathic, meaning it arises spontaneously without a clear origin.

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Symptoms of Cricopharyngeal Achalasia

Cricopharyngeal achalasia is primarily characterized by dysphagia, or difficulty swallowing. Patients often report a sensation of food being stuck in the throat or an inability to swallow liquids and solids effectively. Other symptoms may include:

Regurgitation

Patients may experience regurgitation, wherein undigested food or liquid is expelled back into the throat or mouth. This can occur shortly after eating and may lead to aspiration if the material enters the airway.

Coughing and Choking

Due to impaired swallowing, individuals may frequently cough or choke while eating or drinking. This can be particularly concerning as it increases the risk of aspiration pneumonia.

Weight Loss and Malnutrition

Chronic difficulties with swallowing can lead to significant weight loss and malnutrition as patients may avoid eating or drinking to minimize discomfort.

Sensation of a Lump in the Throat

Known as globus sensation, some patients feel as though there is a persistent lump in their throat, which can cause anxiety and discomfort.

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Diagnosing Cricopharyngeal Achalasia

Accurate diagnosis is crucial for effective management of cricopharyngeal achalasia. Healthcare professionals employ various diagnostic tools to evaluate the condition:

Barium Swallow Study

This imaging test involves swallowing a barium solution, which coats the esophagus and allows for visualization of the swallowing process through X-rays. It can identify abnormalities in the UES and other structures.

Esophageal Manometry

Manometry measures the pressure within the esophagus and UES during swallowing. This test can assess the functionality of the sphincter and identify any abnormalities in muscle contractions.

Endoscopic Evaluation

An endoscope—a flexible tube with a camera—is inserted through the mouth to visually inspect the throat, esophagus, and UES. This procedure can identify structural issues and rule out other conditions.

Videofluoroscopic Swallow Study (VFSS)

VFSS is a dynamic X-ray procedure that evaluates the mechanics of swallowing. It provides detailed information on the coordination of the swallowing process and identifies any dysfunction in the UES.

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Treatment Options for Cricopharyngeal Achalasia

The management of cricopharyngeal achalasia aims to alleviate symptoms, improve swallowing function, and prevent complications. Treatment options may include:

Non-Surgical Interventions

Swallowing Therapy

Speech-language pathologists can provide swallowing therapy to improve swallowing techniques and strengthen the muscles involved in the process.

Dietary Modifications

Modifying the diet to include softer, easier-to-swallow foods can help alleviate symptoms. Patients may also benefit from eating smaller, more frequent meals.

Botulinum Toxin Injections

Injecting botulinum toxin into the cricopharyngeal muscle can temporarily relax the sphincter, improving swallowing function. This is often considered for patients who are not surgical candidates.

Surgical Treatments

Cricopharyngeal Myotomy

Cricopharyngeal myotomy involves surgically cutting the cricopharyngeal muscle to alleviate the obstruction and improve swallowing. This procedure is typically reserved for patients who do not respond to conservative treatments.

Balloon Dilation

Balloon dilation is a less invasive procedure that involves inserting a balloon into the UES and inflating it to stretch and relax the muscle. This can provide relief for some patients, though repeat procedures may be necessary.