Say “Yes” to understanding RCPD

R-CPD, also known as Retrograde Cricopharyngeus Dysfunction, is a disorder characterized by difficulty swallowing due to an inability to relax the upper esophageal sphincter (UES) muscle. This muscle, known as the cricopharyngeus, is located at the top of the esophagus and helps control the passage of food from the throat into the esophagus.

In people with R-CPD, this muscle has difficulty relaxing and opening to allow food and liquid to pass through. This results in a sensation of food getting "stuck" in the throat when trying to swallow. While not a true blockage, the tightness of the UES muscle makes swallowing feel obstructed.

Symptoms of R-CPD may include:

Dysphagia (Difficulty Swallowing):

Patients often report trouble swallowing both solids and liquids.

Swallowing may require extra effort or multiple attempts.

Some describe a sensation of food "getting stuck" in the throat.

Globus Sensation:

A persistent feeling of a lump in the throat, even when not eating or drinking.

This sensation may worsen during or after meals.

Regurgitation:

Undigested food or liquid may come back up into the throat or mouth.

This can occur immediately after swallowing or several hours after eating.

Chest Pain or Discomfort:

Some patients experience pain or pressure in the chest area during or after swallowing.

This discomfort may be mistaken for heartburn or indigestion.

Coughing or Choking:

Frequent coughing or choking episodes during meals.

This can be due to food or liquid entering the airway (aspiration).

Gurgling or Clicking Sounds:

Noticeable gurgling or clicking sounds in the throat during or after swallowing.

These sounds may be audible to others.

Inability to Belch:

Some RCPD patients report difficulty or inability to belch.

This can lead to bloating and discomfort after meals.

Voice Changes:

A "wet" or "gurgly" voice quality, especially after eating or drinking.

Temporary hoarseness or voice changes during meals.

Nasal Regurgitation:

In some cases, food or liquid may come up through the nose during swallowing.

Weight Loss:

Unintended weight loss may occur due to reduced food intake or avoidance of certain foods.

Anxiety Around Eating:

While not a physical symptom, many patients develop anxiety or fear around mealtimes.

This can lead to social isolation or avoidance of eating in public.

Sleep Disturbances:

Nighttime regurgitation can disrupt sleep patterns.

Some patients report waking up coughing or choking.

Recurrent Respiratory Infections:

Due to the increased risk of aspiration, some patients may experience more frequent respiratory infections.

It's important to note that these symptoms can vary in intensity and may not all be present in every case of RCPD. Additionally, many of these symptoms can be associated with other swallowing disorders or medical conditions.

R-CPD is different from regular globus sensation in that the tightness and swallowing difficulties are constant rather than intermittent. The condition can affect people of any age, though symptoms often appear in the late teens and twenties.

While currently there is no cure for R-CPD, several treatments and lifestyle changes can help manage symptoms:

- Learning proper swallowing techniques like tucking the chin, exaggerated swallowing, Mendelsohn maneuver. A speech therapist can provide guidance on modifying swallow function.

- Staying hydrated by sipping water frequently throughout the day.

- Eating soft, well-chewed foods. Avoid dry, dense foods that are hard to swallow.

- Adding sauces and gravies to foods to ease swallowing.

- Taking smaller bites of food and thoroughly chewing each bite.

- Eating slowly and not rushing through meals.

- Avoiding eating when anxious, stressed or distracted. Focus on the act of swallowing.

- Practicing relaxation techniques like diaphragmatic breathing to help relax throat muscles.

For some with R-CPD, Botox injections into the cricopharyngeus muscle may provide temporary relief lasting several months. Gentle stretching of the UES via endoscopic balloon dilation is also occasionally used.

While living with R-CPD can be frustrating, being patient and implementing lifestyle changes can greatly improve comfort with eating and minimize instances of choking and gagging. Support groups can provide community and additional tips for managing dysphagia from R-CPD. With time and practice, it is possible to find an eating routine that enables eating enjoyable foods with minimal impediment.