Swallowing

Retrograde Cricopharyngeal Dysfunction (R-CPD) is a condition in which a person is unable to burp. This happens because a muscle in the upper throat, called the cricopharyngeus muscle, fails to relax when it should — preventing the release of air from the stomach through the throat (retrograde air release).

This can cause uncomfortable symptoms and impact quality of life.

What Are the Symptoms?

People with R-CPD may experience:

• Inability to burp
• Excessive bloating, especially after eating or drinking
• Gurgling or rumbling sounds in the throat or chest
• Chest or abdominal pressure
• Pain or discomfort in the neck, chest, or upper stomach
• Frequent hiccups or nausea
• Relief from symptoms when lying down or by releasing air through the other end of the digestive tract (flatulence)

R-CPD is believed to be caused by a failure of the cricopharyngeus muscle (part of the upper oesophageal sphincter) to relax when needed to allow gas to escape from the oesophagus upward.

The exact reason why this happens is not always known. It is not typically linked to structural abnormalities or diseases.

Diagnosis is based mainly on your symptoms and history. Many patients have lived with symptoms for years before receiving a diagnosis.

Your ENT specialist or speech therapist may perform tests to rule out other causes, which may include:

• Flexible nasendoscopy – to examine the throat and voice box
• Swallowing studies (e.g. videofluoroscopy)
• Manometry – to measure pressure and muscle function in the throat and oesophagus
• CT scan or MRI – rarely needed, unless there are unusual symptoms

The most effective treatment currently available is:

Botulinum Toxin (Botox) Injection into the Cricopharyngeus Muscle

• A small dose of botulinum toxin is injected directly into the cricopharyngeus muscle in the neck.
• This relaxes the muscle, allowing it to open and release trapped air (burping).
• The injection may be performed in a clinic setting, guided by electromyography (EMG).
• Most patients burp for the first time within a few days after the injection.

In many cases, the effect lasts long after the Botox wears off, and patients retain the ability to burp long-term after just one injection.

Please note that this treatment for R-CPD is not currently funded on the NHS.

Botulinum toxin injection is generally safe. Potential side effects may include:

• Temporary difficulty swallowing
• Mild neck discomfort or bruising
• Rarely, voice changes or reflux symptoms

Your doctor will explain the procedure, answer your questions, and assess if it is suitable for you.

Many patients need only one injection to achieve long-term improvement. However, a small number may need a repeat injection if symptoms return.

You should see a specialist if you have:

• Ongoing inability to burp
• Unexplained bloating, discomfort, or gurgling
• Symptoms that affect your quality of life or cause embarrassment

While waiting for treatment:

• Avoid carbonated drinks if they worsen symptoms
• Eat smaller meals
• Avoid lying flat after eating
• Gentle movement (like walking) may help shift gas

• R-CPD is a real condition that causes an inability to burp and symptoms like bloating, chest pressure, and gurgling.
• It is caused by a failure of a muscle in the throat to relax properly.
• Botulinum toxin injection is a highly effective treatment, often providing lasting relief.
• Diagnosis is based on your symptoms, and treatment is available through a specialist ENT clinic.

Cricopharyngeal spasm is a condition where a muscle in your throat, called the cricopharyngeus, becomes overly tight or goes into spasm. This muscle forms part of the upper oesophageal sphincter—the ring of muscle at the top of your food pipe (oesophagus).

When it doesn’t relax properly or goes into spasm, it can cause uncomfortable sensations in the throat, especially when swallowing.

Common symptoms of cricopharyngeal spasm include:

• A lump or tight feeling in the throat (often called globus sensation)
• Discomfort when swallowing, especially solids
• A feeling of food or pills "sticking" in the lower throat
• Intermittent pain in the neck or upper chest
• Frequent throat clearing
• Occasional choking or coughing when eating or drinking

The symptoms can come and go and are not usually dangerous, but they may feel alarming.

Cricopharyngeal spasm can be caused or triggered by:

• Stress or anxiety
• Acid reflux (GORD)
• Muscle tension in the neck or throat
• Age-related changes in muscle control
• Post-surgical or post-radiation changes (rarely)
• Neurological conditions (uncommonly)

In many cases, no clear cause is found, and the spasm is considered functional.

No — while the symptoms can be uncomfortable and distressing, cricopharyngeal spasm is not harmful and does not lead to cancer or structural damage.

However, it’s important to rule out other causes of swallowing difficulty, so you may be referred for further tests.

Diagnosis is based on your symptoms and a physical examination. Your doctor may refer you for tests to rule out other conditions:

• Flexible nasendoscopy – a small camera passed through the nose to look at your throat
• Barium swallow X-ray – to assess how you swallow
• Swallowing manometry – a test that measures muscle function in the throat and oesophagus
• CT or MRI scan – in select cases

Most cases are managed without surgery. Treatment options include:

1. Reassurance and Lifestyle Changes

• Understanding that the condition is benign can reduce anxiety and symptoms
• Eating slower, chewing food well, and sipping water with meals may help

2. Speech and Swallowing Therapy

• Specialised swallowing exercises and techniques taught by a speech and language therapist can improve control of the muscle and reduce symptoms

3. Treating Acid Reflux

• If reflux is contributing, acid-reducing medication (e.g. omeprazole) and dietary changes may be recommended

4. Botulinum Toxin (BoNT-A) Injection

• In cases that do not respond to conservative measures, a small dose of Botox can be injected into the cricopharyngeus muscle to help it relax
• This is usually done through the skin of the neck with EMG guidance
• The effects may last several months, and in some cases, symptoms do not return

Contact your doctor if you:

• Have persistent or worsening symptoms
• Experience unintentional weight loss
• Have difficulty swallowing liquids
• Experience choking or frequent chest pain
• Have new or unusual voice changes

These could suggest a different condition that needs further investigation.

• Cricopharyngeal spasm is a benign muscle tension in the throat
• It can cause tightness, swallowing discomfort, or a lump sensation
• Reassurance, speech therapy, and treating reflux often help
• In stubborn cases, Botox injection can relieve the spasm

Cricopharyngeal Hypertrophy refers to the thickening or dysfunction of a small muscle called the cricopharyngeus, located at the top of your oesophagus (food pipe). This muscle acts like a valve—it opens when you swallow, letting food and drink pass from your throat into your oesophagus, and then closes to prevent backflow.

When this muscle becomes too thick or stiff, it may not relax properly. This can make swallowing uncomfortable or difficult.

The exact cause isn’t always clear, but several factors may contribute:

• Age-related muscle changes: More common in older adults
• Chronic acid reflux (GERD)
• Neurological conditions such as stroke or Parkinson’s disease
• Previous surgery or trauma to the neck or oesophagus
• Chronic coughing or throat clearing
• Radiation therapy to the neck area

In many cases, it’s simply part of the natural aging process.

Symptoms can vary but often include:

• Difficulty swallowing, especially solids
• A sensation that food is getting stuck in the throat
• Frequent throat clearing
• Coughing or choking when eating or drinking
• Regurgitation of food shortly after eating
• Feeling of pressure or fullness in the lower throat or upper chest
• Hoarseness or changes in voice (in some cases)

Symptoms may be mild at first but can become more noticeable over time.

If you’re experiencing symptoms, your doctor may refer you for one or more of the following tests:

• Barium swallow test: An X-ray video taken while you swallow a special liquid, showing how well your muscles work
• Flexible endoscopic evaluation of swallowing (FEES): A thin camera inserted through the nose to observe swallowing
• Oesophageal manometry: Measures pressure and coordination of swallowing muscles
• CT or MRI: Occasionally used to rule out other issues

These tests help confirm the diagnosis and rule out conditions like tumours or strictures.

Treatment depends on how severe your symptoms are and what the underlying cause may be.

1.  Non-Surgical Treatments:

• Swallowing therapy: Exercises and strategies provided by a speech and language therapist to improve muscle coordination
• Diet changes: Softer foods, slower eating, smaller bites, and proper posture
• Acid reflux management: Medications like proton pump inhibitors (PPIs) to reduce inflammation or irritation
• Botulinum toxin (BoNT-A) injection: Temporarily relaxes the cricopharyngeal muscle to improve swallowing

2.  Surgical Treatment (if symptoms persist):

• Cricopharyngeal myotomy: A minor surgery to cut the tight muscle, permanently relaxing it and improving swallowing
• Oesophageal dilation: Stretching the narrowed area using a balloon or instrument during endoscopy

Your doctor will help you decide which option is best for your situation.

Many people experience significant improvement with treatment—especially with therapy and dietary adjustments. If surgery is needed, success rates are generally high, and complications are uncommon.

It’s important to follow up regularly with your care team, especially if you have other medical conditions that affect swallowing.

• Eat slowly and chew food thoroughly
• Avoid dry, crumbly, or sticky foods
• Take sips of water between bites
• Sit upright while eating and remain seated for 30 minutes afterward
• Avoid eating late at night or lying down after meals
• Use any prescribed medications consistently

Let your healthcare provider know if you:

• Are losing weight unintentionally
• Frequently cough or choke when eating
• Feel like food is stuck often or becomes painful to swallow
• Regurgitate undigested food regularly
• Have trouble managing symptoms despite treatment

Cricopharyngeal hypertrophy can be uncomfortable, but it is manageable with the right care and support. You're not alone, and there are effective treatments that can help you enjoy meals and live comfortably.

If you have questions, speak with your doctor or a speech and language therapist—they're here to help.

A pharyngeal pouch, also known as Zenker’s diverticulum, is a condition in which a small outpouching (pocket)forms in the wall of the upper throat, just above the oesophagus (food pipe). It develops in an area where the throat muscles are naturally weaker.

This pouch can collect food or saliva, leading to swallowing difficulties and other symptoms.

Symptoms often develop gradually and may include:

• Difficulty swallowing (especially solids)
• Feeling of food “sticking” in the throat
• Regurgitation of food, sometimes hours after eating
• Coughing, especially when lying down or eating
• Bad breath (halitosis)
• Noisy swallowing
• Throat gurgling
• Unexplained weight loss in more severe cases

In some people, the pouch can grow large enough to be felt as a lump in the neck.

The pouch forms because the cricopharyngeus muscle (part of the upper oesophageal sphincter) does not relax properly when swallowing. This causes pressure to build up in the throat, leading to a small herniation (pouch) through the muscle wall.

It usually occurs in older adults, typically over the age of 60, and is more common in men.

While not cancerous, a pharyngeal pouch can cause significant discomfort and may increase the risk of:

• Aspiration (food or liquid entering the airway/lungs)
• Chest infections
• Malnutrition in severe cases

Rarely, long-standing pouches may develop irritation or inflammation that requires further assessment.

Your doctor may arrange tests to confirm the diagnosis, such as:

• Barium swallow X-ray – shows the size and shape of the pouch
• Flexible nasendoscopy – a thin camera passed through the nose to view the throat
• Endoscopy – a camera passed into the oesophagus under sedation, sometimes done before surgery

If symptoms are bothersome or severe, surgery may be recommended to:

• Open or remove the pouch
• Help the cricopharyngeus muscle relax properly

Surgical options include:

• Endoscopic (through the mouth):
  • Minimally invasive
  • Uses a stapler or laser to divide the wall between the pouch and oesophagus
  • Short recovery time
• Open surgery (through the neck):
  • Used if the pouch is large or endoscopic access is not possible
  • May involve removing the pouch and cutting the tight muscle

Your surgeon will explain the most suitable option for you.

• Most people go home within 1–2 days after surgery
• A soft diet is usually advised for a short period
• Voice changes, sore throat, or mild discomfort are common and usually temporary
• Most patients notice immediate improvement in swallowing and regurgitation

Surgical treatment is usually safe, but all procedures carry some risks:

• Bleeding
• Infection
• Leakage from the surgical site (rare)
• Temporary hoarseness or swallowing changes
• Recurrence of the pouch (uncommon, but possible)

Contact your doctor if you experience:

• Ongoing or worsening swallowing difficulty
• Weight loss
• Frequent coughing or chest infections
• Regurgitation of undigested food
• Concerns about food going “down the wrong way”

• A pharyngeal pouch is a pocket in the throat that can cause swallowing issues and regurgitation.
• It is not cancer, but it can be uncomfortable and affect your quality of life.
• Treatment is often highly effective, especially with surgery.
• Most people recover well and notice a big improvement in symptoms.