It has been hypothesised that cricopharyngeal muscle hypertrophy develops as a response to chronic gastro-oesophageal reflux disease. The cricopharyngeus muscle is an important component and contributor to the upper oesophageal sphincter that creates a barrier between the pharynx and oesophagus. Cricopharyngeal muscle dysfunction is usually identified on a barium study through the presence of a cricopharyngeal bar, cricopharyngeal web or a zenkers diverticulum / pharyngeal pouch. The investigators in this study retrospectively reviewed their database of video-oesophagrams. They sought to test the hypothesised association between gastro-oesophageal reflux and cricopharyngeal muscle dysfunction using the appearance of a hiatus hernia on videofluoroscopic oesophagrams as a surrogate for the presence of gastro-oesophageal reflux. They compared findings from 50 patients with confirmed hiatus hernia (defined as at least a 2cm extension of the oesophago-gastric junction above the diaphragmatic hiatus) with the next chronologically adjacent patient matched for age and gender on their database. They found that cricopharyngeal muscle dysfunction was present in 78% of the group of patients with hiatus hernia compared to 58% in the matched control group (p<0.05). Their results suggested that patients with hiatus hernia (and therefore likely gastro-oesophageal reflux) were 2.57 times more likely to demonstrate cricopharyngeal muscle dysfunction (95% CI 1.07 – 6. 15). The opening of the pharyngo-oesophageal sphincter was also significantly smaller in the group with hiatus hernia. Whilst further research is required to establish a definite causal link, these findings have implications for managing the condition clinically.

The Relationship Between Hiatal Hernia and Cricopharyngeus Muscle Dysfunction.
Nativ-Zeltzer N, Rameau A, Kuhn MA,
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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