Hypertonicity of the Cricopharyngeal Sphincter: A Cause of Globus Sensation

Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease

“…The closer to the UES that acid is instilled, the higher the pressure produced. Some argue that this is a protective reflex designed to prevent acid reflux into the lungs [11], and often repeated reflux into the esophagus may lead to sustained increase in tone of the UES [11,14], a phenomenon that is observed in GERD patients. It can be anticipated that three fluoroscopic abnormalities would occur in such patients: a delay in relaxation (with transient stressing of Killian's dehiscence by the increased pressure in the hypopharynx), incomplete relaxation with the presence of a cricopharyngeal bar, and premature contraction of the cricopharyngeus before the tail of the bolus had completely cleared the pharynx.…”

“…Functional cricopharyngeal disturbance is known to cause dysphagia, with symptoms varying from a "lump in the throat" to severe difficulty in swallowing [5,14]. The direct relationship between GER and cricopharyngeal prominence is controversial [3], but a positive correlation between clinical assessment of GER (but not its radiologic confirmation) and a visible cricopharyngeal impression on the barium bolus has been demonstrated [15].…”

Recent Developments in the Manometric Assessment of Upper Esophageal Sphincter Function and Dysfunction

“…Abnormal UES Function and 'Cricopharyngeal Achalasia ' Although increased resting UES pressure ('hypertensive UES'; 'spasm') may occasion ally be found in patients with a globus sensa tion or in patients with chronic gastroesopha geal reflux, it is not a common finding with either entity, and its importance remains con troversial [13][14][15], The potential for a clinical ly important 'hypotensive UES' is even more suspect, but is occasionally proposed as a mechanism for esophagopharyngeal regurgi tation and aspiration [14,16]. A diagnosis of 'cricopharyngeal achalasia' is frequently sug gested when impaired transfer of barium from pharynx to upper esophagus is seen radio graphically.…”

“…Over the years, it has been used primarily in patients with pharyn goesophageal (Zenker's) diverticula. The uni versal acceptance of cricopharyngeal myoto my in the treatment of this condition now appears even more appropriate based on re cent observations of restricted compliance of this muscular sphincter [13].…”

Psychophysiological Disorders of the Gastrointestinal Tract

“…Although physical disorders such as hiatal hernia, increased cricopharyngeal pressures, reflux esophagitus, or cervical spinal anomalies have been suggested as the cause of globus hystericus (Malcomson, 1966;Watson & Sullivan, 1974), it appears that these disorders do not sufficiently account for the symptms of globus in many patients (Caldarelli, Andrews, & Derbyshire, 1970;Mair, Schroder, Modalsli, & Maurer, 1974). Globus is reported more often in women than in men and occurs primarily between meals.…”