{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:20:26Z","timestamp":1787167226396,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["Ricerca Corrente 2022\u20132024"],"award-info":[{"award-number":["Ricerca Corrente 2022\u20132024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Retrograde cricopharyngeus dysfunction (R-CPD) is a recently recognized condition characterized by the inability to burp, typically accompanied by gurgling noises, bloating, and flatulence. Percutaneous botulinum neurotoxin (BoNT) injection into the cricopharyngeus muscle is a minimally invasive treatment with promising effects, although current evidence remains limited. In this prospective, open-label study, we evaluated the clinical effects of increasing doses (10 to 30 U) of EMG-guided unilateral BoNT injection in 67 patients with R-CPD. Symptom severity and quality of life were assessed at baseline and at 1 and 4 months post-treatment. The electromyographic (EMG) parameters of the cricopharyngeus were recorded to explore their association with symptom burden and treatment response. At a 1-month follow-up, 55.2% of patients were classified as responders (satisfaction score \u2265 6\/10), with a higher rate (64.4%) observed at higher doses, particularly in female patients. Both symptom severity and quality of life improved significantly at 1 month and were sustained at 4 months. Higher cricopharyngeus EMG activity was associated with more severe symptoms and lesser treatment responses. Unilateral EMG-guided BoNT injection is a safe and effective treatment for R-CPD. Further studies should explore the potential role of electromyography in clarifying the pathophysiological aspects of R-CPD and guiding treatment.<\/jats:p>","DOI":"10.3390\/toxins17090458","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T13:43:02Z","timestamp":1757684582000},"page":"458","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Unilateral EMG-Guided Botulinum Toxin for Retrograde Cricopharyngeus Dysfunction: A Prospective Clinical and Neurophysiological Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-6410","authenticated-orcid":false,"given":"Giuseppe","family":"Cosentino","sequence":"first","affiliation":[{"name":"Department of Brain and Behavioral Sciences, University of Pavia, Campus della Salute, presso Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3974-844X","authenticated-orcid":false,"given":"Chiara","family":"Zaffina","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Zoccola","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Fresia","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Merli","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Mauramati","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2840-5184","authenticated-orcid":false,"given":"Giulia","family":"Bertino","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6527-3558","authenticated-orcid":false,"given":"Massimiliano","family":"Todisco","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8323-2290","authenticated-orcid":false,"given":"Shayan","family":"Dodge","sequence":"additional","affiliation":[{"name":"Department of Energy, Systems, Territory and Construction Engineering (DESTEC), University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1414-1114","authenticated-orcid":false,"given":"Sami","family":"Barmada","sequence":"additional","affiliation":[{"name":"Department of Energy, Systems, Territory and Construction Engineering (DESTEC), University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Alfonsi","sequence":"additional","affiliation":[{"name":"Translational Neurophysiology Research Section, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1513-2113","authenticated-orcid":false,"given":"Cristina","family":"Tassorelli","sequence":"additional","affiliation":[{"name":"Department of Brain and Behavioral Sciences, University of Pavia, Campus della Salute, presso Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2473974X19834553","DOI":"10.1177\/2473974X19834553","article-title":"Inability to belch and associated symptoms due to retrograde cricopharyngeus dysfunction: Diagnosis and treatment","volume":"3","author":"Bastian","year":"2019","journal-title":"OTO Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5087","DOI":"10.1007\/s00405-021-06790-w","article-title":"Abelchia: Inability to belch\/burp\u2014A new disorder? 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