{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:03:48Z","timestamp":1765382628766,"version":"3.44.0"},"reference-count":10,"publisher":"Danish Medical Association","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dan Med J"],"abstract":"<jats:p>INTRODUCTION. Retrograde cricopharyngeal dysfunction (R-CPD) is the inability to belch due to impaired upper oesophageal sphincter relaxation. Botulinum toxin A injection shows promise, but standardised protocols are lacking. Objective: To evaluate the effect of botulinum toxin A for R-CPD in a Danish population.\nMETHODS. A retrospective case series study at Aarhus University Hospital included R-CPD patients treated from January 2021 to December 2024. The diagnosis was clinical, supported by otorhinolaryngological examination, modified barium swallow and oesophagoscopy. Under general anaesthesia, all patients received 50 IU of botulinum toxin A into the cricopharyngeal muscle. Symptom relief and adverse effects were assessed at follow-ups performed at two weeks and three months. Statistical analysis with Fisher\u2019s exact test compared treatment responses in patients aged 18-25 years versus those over 25 years.\n\nRESULTS. Among 40 patients (22 males, 18 females, mean age 27.5 years), 35 experienced symptom relief within two weeks. Long-term follow-up (31 patients) showed that 18 continued to belch after three months. Thirteen patients required additional treatments with botulinum toxin A doses increased to 75-100 IU, 24 achieved satisfactory results, while nine await further procedures.\nCONCLUSIONS. Botulinum toxin A is a safe, effective R-CPD treatment with minor side effects (transient dysphagia, mild sore throat, sour eructation) and no vocal fold or respiratory complications. Over half of the patients improved after 50 IU treatment, whereas one-third required dose escalation, suggesting that 100 IU may enhance outcomes.\nFUNDING. None.\n\nTRIAL REGISTRATION. Not relevant.<\/jats:p>","DOI":"10.61409\/a03250166","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T11:16:50Z","timestamp":1753960610000},"page":"1-8","source":"Crossref","is-referenced-by-count":1,"title":["Retrograde cricopharyngeal dysfunction management with botulinum toxin A"],"prefix":"10.61409","author":[{"given":"Dalia Gustaityte","family":"Larsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathilde","family":"Aalling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nichlas","family":"Udholm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padraig","family":"O\u2019Leary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"40208","published-online":{"date-parts":[[2025,7]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Bastian RW, Smithson ML. Inability to belch and associated symptoms due to retrograde cricopharyngeus dysfunction: diagnosis and treatment. OTO Open. 2019;3(1)2473974X19834553. https:\/\/doi.org\/10.1177\/2473974X19834553","DOI":"10.1177\/2473974X19834553"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Kahrilas PJ, Dodds WJ, Hogan WJ. Dysfunction of the belch reflex: a cause of incapacitating chest pain. Gastroenterology. 1987;93(4):818-822. https:\/\/doi.org\/10.1016\/0016-5085(87)90445-8","DOI":"10.1016\/0016-5085(87)90445-8"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Chen JN, Evans J, Fakhreddine AB, et al. Retrograde cricopharyngeus dysfunction: how does the inability to burp affect daily life? Neurogastroenterol Motil. 2024;36(2):e14721. https:\/\/doi.org\/10.1111\/nmo.14721","DOI":"10.1111\/nmo.14721"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Karagama Y. Abelchia: inability to belch\/burp - a new disorder? Retrograde cricopharyngeal dysfunction (RCPD). 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OTO Open. 2021;5(1):2473974X21989587. https:\/\/doi.org\/10.1177\/2473974X21989587","DOI":"10.1177\/2473974X21989587"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Dutta SR, Pasisi D, Singh M, et al. Botulinum toxin: the poison that heals: a brief review. Natl J Maxillofac Surg. 2016;7(1):10-16. https:\/\/doi.org\/10.4103\/0975-5950.196133","DOI":"10.4103\/0975-5950.196133"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Hoesli RC, Wingo ML, Bastian RW. The long-term efficacy of botulinum toxin injection to treat retrograde cricopharyngeus dysfunction. OTO Open. 2020;4(2):2473974X20938342. https:\/\/doi.org\/10.1177\/2473974X20938342","DOI":"10.1177\/2473974X20938342"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Yousef A, Krause A, Yadlapati R, et al. Upper esophageal sphincter and esophageal motility pathology on manometry in retrograde cricopharyngeal dysfunction. Otolaryngol Head Neck Surg. 2024;171(2):478-485. https:\/\/doi.org\/10.1002\/ohn.735","DOI":"10.1002\/ohn.735"}],"container-title":["Danish Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T13:11:50Z","timestamp":1758892310000},"score":1,"resource":{"primary":{"URL":"https:\/\/ugeskriftet.dk\/dmj\/A03250166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":10,"URL":"https:\/\/doi.org\/10.61409\/a03250166","relation":{},"ISSN":["2245-1919"],"issn-type":[{"type":"electronic","value":"2245-1919"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}