Cricopharyngeal myotomy does not increase the risk of esophagopharyngeal acid regurgitation

OBJECTIVE: It is not known whether cricopharyngeal myotomy predisposes to e sophagopharyngeal regurgitation. Using ambulatory, dual pharyngeal, and eso phageal pH monitoring before and after cricopharyngeal myotomy, our aim was to determine the effect, if any, of myotomy on the frequency of esophagoph aryngeal acid regurgitation. METHODS: We studied prospectively Is patients who underwent cricopharyngeal myotomy for pharyngeal dysphagia (10 Zenker's, eight neurogenic dysphagia) , of whom 17 agreed to undergo dual pH monitoring preoperatively, and 10 wh o agreed to both pre- and postoperative monitoring. RESULTS: Symptoms of gastroesophageal reflux disease were present in 30%. C ricopharyngeal myotomy significantly reduced basal upper esophageal sphinct er pressure by 49%, from 37 +/- 5 mm Hg to 19 +/- 3 mm Hg (p = 0.007). Esop hagopharyngeal regurgitation was a rare event and the frequency of it did n ot differ between patients and healthy controls. Preoperatively, three regu rgitation events in two patients did not differ from the postoperative freq uency of a total of two events in the same two patients. CONCLUSIONS: Increased esophageal acid exposure is common and esophagophary ngeal regurgitation is rare in unselected patients undergoing cricopharynge al myotomy for pharyngeal dysphagia. Myotomy does not increase the frequenc y of esophagopharyngeal acid regurgitation in such patients. (Am J Gastroen terol 1999;94:3448-3454. (C) 1999 by Am. Coll. of Gastroenterology).