Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation

Background: Primary cricopharyngeal dysfunction (PCD) is a rare, idiopathic , functional disorder of the upper esophageal sphincter, characterized by d ysphagia, frequent aspiration, and functional narrowing at the level of the upper esophageal sphincter. Methods: Five of 29 patients with oropharyngeal dysphagia were found to hav e PCD. Patients presented with severe dysphagia and predisposition to aspir ation. Radiography demonstrated narrowing at the level of the upper esophag eal sphincter and aspiration. An endoscope could be introduced into the eso phagus in only 2 patients before dilation. Observations: In contrast to organic stenoses, these functional upper esoph ageal sphincter stenoses were dilated without difficulty with a balloon cat heter. After low-pressure (1.5-2 atm) progressive balloon dilation (to 20 m m), superficial mucosal injury was observed only in one patient. After dila tation, symptoms resolved and barium swallow demonstrated normal passage th rough the upper esophageal sphincter. During a mean followup of 21 months ( 7-33), redilation was necessary in only 1 case. Conclusions: Balloon catheter dilatation of PCD is mink mally invasive and provides both important diagnostic information and effective therapy. It sh ould be the first choice of therapy for PCD.