Cricopharyngeal bar

Cricopharyngeal bar refers to the radiographic appearance of a prominent cricopharyngeus muscle contour on barium swallow.

Terminology

The terms cricopharyngeal bar and cricopharyngeal muscle spasm/achalasia are often used synonymously but this is incorrect because studies have demonstrated that presence of a cricopharyngeal bar is not always related to cricopharyngeus spasm but can be due to other pathologies .

Epidemiology

Present in up to 20% of barium studies .

Clinical presentation

Mostly asymptomatic and found as an incidental finding on barium swallow. One-third of patients may complain of dysphagia but a cricopharyngeal bar is rarely a cause .

Pathology

Causes include :

• idiopathic (i.e. normal variant)
• cricopharyngeal muscle spasm/achalasia (i.e. failed relaxation)
• cricopharyngeus muscle hypertrophy and/or fibrosis

Associations

• seen in up to 50% of patients with gastro-esophageal reflux disease 

Radiographic features

Fluoroscopy

On barium swallow lateral projection:

• smooth posterior indentation of the esophagus at the level of C5-C6

Treatment and prognosis

In selected patients with no other cause for dysphagia demonstrated, cricopharyngeal bars can be treated with a myotomy, esophageal dilatation and/or botulinum toxin injection .

Complications

• due to increased upper esophageal pressure may result in a Zenker diverticulum