The terms cricopharyngeal bar and cricopharyngeal muscle spasm/achalasia are often used synonymously but this is incorrect because studies have demonstrated that presence of a cricopharyngeal bar is not always related to cricopharyngeus spasm but can be due to other pathologies 4.
Present in up to 20% of barium studies 1.
Mostly asymptomatic and found as an incidental finding on barium swallow. One-third of patients may complain of dysphagia but a cricopharyngeal bar is rarely a cause 1,5.
Causes include 1,2:
- idiopathic (i.e. normal variant)
- cricopharyngeal muscle spasm/achalasia (i.e. failed relaxation)
- cricopharyngeus muscle hypertrophy and/or fibrosis
- seen in up to 50% of patients with gastro-esophageal reflux disease 6
On barium swallow lateral projection:
- smooth posterior indentation of the esophagus at the level of C5-C6
Treatment and prognosis
In selected patients with no other cause for dysphagia demonstrated, cricopharyngeal bars can be treated with a myotomy, esophageal dilatation and/or botulinum toxin injection 5,6.
- due to increased upper esophageal pressure may result in a Zenker diverticulum 2
- 1. Cook I. Cricopharyngeal bar and zenker diverticulum. Gastroenterol Hepatol (N Y). 2012;7 (8): 540. Free text at pubmed - Pubmed citation
- 2. Radiology of the Stomach and Duodenum. Springer. ISBN:3540424628. Read it at Google Books - Find it at Amazon
- 3. Wang A, Kadkade R, Kahrilas P et-al. Gastrointestinal Endoscopy. 2005;61 (1): . doi:10.1016/S0016-5107(04)02447-2
- 4. Foregut. John Libbey Eurotext. ISBN:2742007210. Read it at Google Books - Find it at Amazon
- 5. Irvine EJ. Evidence-Based Gastroenterology. pmph usa. ISBN:1550091050. Read it at Google Books - Find it at Amazon
- 6. The Esophagus. Wiley-Blackwell. ISBN:1405198648. Read it at Google Books - Find it at Amazon
- 7. Azpeitia Armán J, Lorente-Ramos RM, Gete García P, Collazo Lorduy T. Videofluoroscopic Evaluation of Normal and Impaired Oropharyngeal Swallowing. (2019) Radiographics : a review publication of the Radiological Society of North America, Inc. 39 (1): 78-79. doi:10.1148/rg.2019180070 - Pubmed
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