Outcomes in the Management of Pediatric Retrograde Cricopharyngeal Dysfunction

OBJECTIVE: To review the presentation and treatment outcomes of pediatric patients with retrograde cricopharyngeal dysfunction (RCPD). METHODS: A retrospective chart review was performed on pediatric patients diagnosed with retrograde cricopharyngeal dysfunction (RCPD) and treated with cricopharyngeal botulinum toxin injection (CPBTI). Patient-specific demographic, clinical, and treatment data were collected with a focus on outcomes and complications. RESULTS: Twenty-five patients were identified (mean ± SD age, 14.4 ± 3.91; range 4-17). Eighteen (72%) patients were female. Common presenting symptoms included inability to belch (100%), bloating (96%), excessive flatulence (92%), and gurgling sounds from the throat (88%). Patients under 5 years of age were noted by parents to have visible abdominal distention and food aversion. Eleven patients (46%) had social anxiety related to their symptoms prior to intervention. Seven (28%) had alternate diagnoses prior to initial consultation. The average duration of follow-up was 247 days. All patients (100%) experienced symptomatic improvement, with 88% noting complete symptom resolution and 12% noting reduced symptoms. Only one patient required a second injection to maintain their treatment response. CONCLUSION: RCPD presents similarly in both pediatric and adult patients, though the ability to verbally express symptoms may limit recognition in younger patients. Pediatric patients appear to better tolerate expected side effects of treatment and demonstrate a higher overall long-term success rate when compared to adult outcomes in the literature. Increased recognition and treatment of RCPD in children may help minimize long term sequelae of the condition while also affording decreased treatment morbidity.