A cricopharyngeal bar on lateral radiographs of barium swallows is noted in some of patients who undergo pharyngeal and esophageal radiographic examination. Reduced compliance by fibrosis has been the explanation for the bar. The bolus flow through the upper esophageal sphincter is the same as that observed in healthy subjects. The increased resistance to flow markedly raises the forces required to drive bolus passage. The intrabolus pressure in the hypopharynx of these patients is higher than in healthy subjects. The increase in intrabolus pressure depends on the distended pharyngoesophageal segment during swallows, with a more significant increase associated with a smaller upper esophageal sphincter diameter and an increase of bolus volume. Most of the time, cricopharyngeal bar is an unexpected and incidental observation on an esophageal radiologic examination. The bar may not cause symptoms, but when it is present dysphagia is the most frequent complaint. However, the cause of dysphagia may be pharyngeal and esophageal motor abnormalities and not the cricopharyngeal bar, a possibility that should be investigated. If the patient has dysphagia, he should be investigated by radiologic, endoscopic and manometric examinations. The treatment involves some options, as surgery, dilatation or botulin toxin.
KeywordsZenker’s diverticulum Cricopharyngeal bar Upper esophageal sphincter (UES) Pharyngoesophageal segment (PES) Cricopharyngeal (CP) muscle
- 12.Pal A, Williams RB, Cook IJ, Brasseur JG. Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow. Am J Physiol. 2003;285:G1037–48.Google Scholar
- 13.Olsson R, Ekberg O. Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation. Acta Radiol. 1995;2:597–601.Google Scholar