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Cricopharyngeal Hypertrophy – Achalasia

What is it?
The cricopharyngeus is a circular muscle that forms the upper esophageal sphincter.  This ring of muscle relaxes as one swallows to allow food and liquid into the esophagus, then contracts to prevent the reflux of contents from the esophagus and stomach.  For a variety of reasons, but often related to the reflux of gastic acid (gastroesophageal reflux, see below), the cricopharyngeus enlarged and tight.  Symptomatic patients often have difficulty swallowing solid foods and develop globus sensation.  Cricopharyngeal hypertrophy can lead to the development of a Zenker’s diverticulum (see above).

How is it treated?
After being confirmed with a special imaging study, a number of approaches to treatment are possible.  Medications typically aim at reducing the acid reflux that commonly causes the disorder.  Persistent hypertrophy can be treated by office-based dilations or injection of botulinum toxin to relax the muscle.  Finally, persistently symptomatic patients may choose to undergo endoscopic incisional release of the muscle to resolve symptoms.  In some cases, an open surgical procedure is required.

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