Swallowing Problems

Treatment of Cricopharyngeus Bar

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The cricopharyngeus (CP) muscle is the lowest horizontal bandlike muscle of the throat. The esophagus begins just below the cricopharyngeus, which acts as a one-way valve. It remains tight and closed to keep stomach and esophageal contents from coming back up into the throat during straining or bending over. During a swallow, it temporarily relaxes to allow food to pass.

A number of diseases can affect the cricopharyngeus muscle, causing an obstruction in the lower throat. People with this type of obstruction complain of solids sticking in their throat. When this occurs, a CP bar (indentation) is seen on the videofluoroscopy. Some individuals may have a CP bar that does not cause swallowing difficulty. The condition is usually evaluated by a physician in Otorhinolaryngology and/or a speech-language pathologist.

Manofluorography is a good test to determine if the CP is opening properly. The test measures the intrabolus pressure gradient across the CP muscle. If this gradient is elevated, dividing the CP muscle may relieve the obstruction and improve swallowing. This procedure is a CP myotomy.

A CP myotomy may be done by open surgery or an endoscopic approach. The endoscopic approach uses a laser and is faster and has a lower complication rate than the open approach. Both approaches are done as an outpatient or an overnight stay in the hospital.