Title: Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar - ScienceDirect
Headings: Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar
Gastrointestinal Endoscopy
Case Study
Effectiveness of esophageal dilation for symptomatic cricopharyngeal bar
Background
Methods
Observations
Conclusions
Patients and methods
Observations
Representative case
Discussion
References

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Dysfunction of the upper esophageal sphincter (UES) is a primary cause of oropharyngeal or “transfer” dysphagia and can be associated with significant morbidity. 1, 2, 3, 4, 5 The UES is a complex structure that is composed of the cricopharyngeus, the inferior pharyngeal constrictor, and the proximal cervical esophagus, with each muscle contributing differentially, depending on the physiologic state of the sphincter. 6 The major component of the UES is the cricopharyngeus or cricopharyngeal (CP) muscle. 6, 7, 8, 9, 10, 11, 12
A CP bar is noted in 5% to 19% of patients who undergo dynamic pharyngeal radiography. 5, 8 It appears as a prominent, persistent, posterior indentation at the level of the lower third of the cricoid cartilage and is best visualized radiographically in the lateral projection. 9 A CP bar is difficult to appreciate on endoscopic examination. Histopathologic examination of CP bars from patients who have undergone surgical myotomy has demonstrated muscle fiber degeneration and interstitial fibrosis. 12, 13 Some studies 1, 2, 9, 14 have suggested that CP bar is a primary cause of oropharyngeal dysphagia (OPD), particularly in the elderly. Because CP bars frequently are detected in asymptomatic individuals, other etiologies of dysphagia must be excluded before dysphagia can be attributed to a CP bar. 5
Therapy for OPD attributed primarily to a CP bar has not been investigated thoroughly, but traditionally relies upon surgical CP myotomy.