The Mental Health Impact of Retrograde Cricopharyngeus Dysfunction (RCPD) and Its Treatment.

Abstract

RCPD is a condition characterized by the inability to belch. Our study aims to assess the prevalence of anxiety and depression within this population while evaluating the impact of cricopharyngeal botulinum toxin injection (CPBTI) on associated symptoms. RCPD patients selected for treatment with CPBTI were given three validated questionnaires for anxiety (GAD-7, ASQ) and depression (PHQ-9) before CPBTI, as well as 6 weeks and 6 months after. The changes were assessed with ANOVA, and minimal clinically important differences (MCID) of the surveys were used to qualify improvement in scores. Seventy-seven patients completed the pretreatment questionnaire. Of the 69 patients who ultimately received treatment, 45 completed at least one follow-up questionnaire and 32 completed all three. Mean age was 30.9% and 61% self-reported a diagnosed mental health comorbidity (MHC). GAD-7 identified at least mild anxiety in 73%, 50%, and 46% of patients at each timepoint, respectively. PHQ-9 identified at least mild depression in 68%, 52%, and 34%, respectively. Mean pretreatment, 6-week, and 6-month scores were 8.16, 5.04, and 4.4, respectively, for GAD-7 (p < 0.001); 7.87, 5.71, and 4.20, respectively, for PHQ-9 (p = 0.002); and 112.4, 75.6, and 65.20, respectively, for ASQ (p = 0.001). Using MCID values for GAD-7 and PHQ-9, 64% showed significant improvement in anxiety and 60% showed significant improvement in depression after treatment. RCPD patients have a high prevalence of comorbid anxiety and depression. Treatment with CPBTI correlates strongly with a sustained reduction in these symptoms beyond the duration of botulinum toxin.