A-CPD

This is the same muscle as R-CPD, the cricopharyngeus at the top of the esophagus, failing in the other direction. When you swallow, it is supposed to relax and open for about a second. In A-CPD it does not open fully, so food on its way down meets a door that is only partly open¹.

The A stands for antegrade, which means forward, in the direction of swallowing. Laryngopedia uses the name to pair it with R-CPD¹. In most of the medical literature it is just called cricopharyngeal dysfunction or cricopharyngeal achalasia. When the tight muscle shows up on an X-ray as a ridge on the back wall of the throat, it is called a cricopharyngeal bar².

The cause is usually unknown. It tends to get slowly worse over years¹. It can also come with conditions that affect nerves and muscles, such as a stroke³.

Pills and solid food catch at the bottom of your throat, somewhere in the middle to lower neck¹. Drinks usually still go down. You might need two or three swallows to clear one bite⁴.

Over months or years, people change how they eat without really deciding to. Smaller bites, softer food, fewer things like steak and bread. Eventually even foods that used to be easy start to catch¹. A feeling of a lump in the throat, or tightness when you swallow, is common². Some people cough or choke while eating because food or drink goes down the wrong way³.

From R-CPD. Same muscle, opposite direction. R-CPD blocks air coming up and leaves swallowing normal. A-CPD makes swallowing hard and has nothing to do with burping^1,5. A-CPD is mostly a condition of older adults. In a study of 250 people with a tight cricopharyngeus, most of whom also had a Zenker's pouch, the mean age was 69⁶.

From Zenker's. Zenker's is a pouch that forms just above a cricopharyngeus that does not open well, so the two often go together. A-CPD is the tight muscle. Zenker's is the pocket that the pressure can push out above it^7,8. The signs that point to a pouch are food coming back up undigested, bad breath, and gurgling in the neck^9,10. Age does not help here: in the same 250-person study, people without a pouch were no younger than people with one⁶.

From achalasia and spasm. Trouble with drinks as well as food, and a feeling of things stopping behind the breastbone, usually point lower down. But where you feel it is only a rough guide. Problems at the bottom of the esophagus can be felt in the neck too⁴. That is one reason the test matters more than the description.

The main test is a videofluoroscopic swallow study, also called a modified barium swallow. You swallow barium in different textures while an X-ray video records it, often run together with a speech-language pathologist². Some clinics add high-resolution manometry of the throat. There are still no agreed criteria for the diagnosis².

A doctor will usually also look at your throat with a small camera (laryngoscopy) to rule out other causes³.

The people to ask for are an ear, nose and throat doctor or laryngologist, and a speech-language pathologist who does swallow studies.

• Dilation. Stretching the sphincter with a large dilator, under anesthesia. In 46 patients, 64% improved, and the benefit lasted a median of about two years¹¹.
• Botox. Injected into the cricopharyngeus, guided by EMG, ultrasound or a scope, to relax it for a few months^2,12.
• Myotomy. Cutting the muscle so it can no longer clamp shut. Laryngopedia's surgeons mostly do it through the mouth with a laser under general anesthesia¹. Many others use a cut on the left side of the neck. After the laser approach, people usually stay one night and eat liquids and soft food for about a week³.
• Swallowing therapy. Exercises with a speech-language pathologist, such as a head-lift exercise. The evidence for these is mixed².

Dilation or Botox is often tried first to see whether opening the sphincter helps before it is cut. No study has settled the best order².

• All three treatments help most people. A systematic review of 32 studies from 1990 to 2013 found average success, weighted by number of patients, of 69% for Botox, 73% for dilation and 78% for myotomy. Myotomy did significantly better than Botox but was not clearly better than dilation, and myotomy through the mouth did better than open surgery (odds ratio 2.2)¹³. The ranges between studies were very wide, from 43% to 100% for Botox, and the review gives no confidence intervals.
• Dilation often has to be repeated. Of 23 people with a cricopharyngeal bar who had dilation, 83% felt better, but 74% had symptoms that stayed or came back and 57% needed another dilation. Of 20 who had a myotomy, 95% had no recurrence¹⁴.
• The benefit of surgery holds. In a prospective study of 160 people having surgery on this muscle, most of whom had a Zenker's pouch, scores on the 40-point EAT-10 swallowing questionnaire were a median 12 points better a year later, and the gain mostly held¹⁵.
• How sure we can be. Nearly all of this comes from observational studies. There is no randomized trial comparing the three treatments head to head, and a 2026 meta-analysis of Botox found the studies disagreed with each other a great deal¹².

Get email alerts about new potential studies

2 studies are listed as recruiting or not yet recruiting for A-CPD. See the studies and follow updates.