Cricopharyngeal Bar
A cricopharyngeal bar is a radiological finding that appears on imaging studies of the throat, specifically during barium swallow examinations. This condition involves the cricopharyngeal muscle at the junction between the throat and esophagus. The muscle creates a visible indentation on X-ray images when it fails to relax properly during swallowing.
What Is a Cricopharyngeal Bar
A cricopharyngeal bar is an abnormal prominence or thickening of the cricopharyngeal muscle that appears on imaging studies of the throat. This muscle sits at the top of the esophagus, right where your throat connects to the tube that carries food to your stomach. When this muscle doesn’t relax properly during swallowing, it creates a visible indentation or shelf-like appearance on X-ray images, which radiologists call a cricopharyngeal bar.
The cricopharyngeal muscle normally acts like a one-way valve, opening to let food and liquids pass from your throat into your esophagus, then closing to prevent stomach contents from backing up. When this muscle becomes too tight or fails to coordinate properly with swallowing, it can create the imaging appearance that gives this condition its name.
Cricopharyngeal Bar Symptoms and Signs
People with a cricopharyngeal bar can experience difficulty swallowing, medically known as dysphagia. The most common symptoms include feeling like food gets stuck in the throat, particularly when swallowing solid foods. Many patients describe a sensation of food hanging up at the base of their throat or feeling like they need to swallow multiple times to clear food completely.
Other symptoms may include choking episodes during meals, coughing while eating or drinking, and the need to drink extra liquids to help food go down. Some people notice that certain foods, especially dry or sticky items like bread or peanut butter, cause more problems than others. In severe cases, patients might avoid certain foods altogether or experience weight loss due to eating difficulties.
Cricopharyngeal Bar Imaging Findings
The cricopharyngeal bar shows up most clearly on barium swallow studies, which are specialized X-ray examinations where patients drink a chalky liquid called barium contrast. This contrast material coats the inside of the throat and esophagus, making these structures visible on X-ray images.
On these studies, a cricopharyngeal bar appears as a smooth, horizontal indentation on the back wall of the upper esophagus. Radiologists describe it as a posterior impression or shelf-like defect that creates a narrowing where the pharynx meets the esophagus. The bar typically measures a few millimeters in height and extends across the width of the esophageal opening.
CT scans and MRI studies can sometimes show thickening of the cricopharyngeal muscle, but barium swallow studies remain the gold standard for diagnosing this condition. The dynamic nature of swallowing studies allows doctors to see how the muscle behaves during the actual act of swallowing, which static images cannot provide.
Cricopharyngeal Muscle Dysfunction Causes
Several factors can lead to cricopharyngeal muscle dysfunction and the development of a cricopharyngeal bar. Age-related changes are among the most common causes, as the coordination between different muscle groups involved in swallowing can deteriorate over time. This explains why cricopharyngeal bars are more frequently seen in older adults.
Neurological conditions can also affect the normal function of the cricopharyngeal muscle. Stroke, Parkinson’s disease, multiple sclerosis, and other neurological disorders can disrupt the complex nerve signals that coordinate swallowing. These conditions may cause the muscle to contract at the wrong time or fail to relax completely during swallowing.
Gastroesophageal reflux disease, commonly known as GERD, can contribute to cricopharyngeal dysfunction. Chronic acid exposure can cause inflammation and scarring of the muscle and surrounding tissues, leading to poor coordination and muscle tightness.
Previous surgery or radiation treatment to the neck area can also result in scar tissue formation and muscle dysfunction. Cancer treatments, in particular, can cause long-term changes in muscle function and coordination.
Upper Esophageal Sphincter Problems
The cricopharyngeal muscle is part of what doctors call the upper esophageal sphincter, a ring of muscles that controls the entrance to the esophagus. When this sphincter doesn’t work properly, it can create several problems beyond just the imaging appearance of a cricopharyngeal bar.
Upper esophageal sphincter dysfunction can lead to aspiration, where food or liquids accidentally enter the windpipe instead of the esophagus. This can cause coughing, choking, and potentially serious lung infections called aspiration pneumonia. The risk is particularly high for thin liquids, which can slip past a poorly functioning sphincter more easily than thicker substances.
The sphincter problems can also cause food to collect in small pouches that form in the throat area, called pharyngeal pouches or Zenker’s diverticulum. While not directly caused by the cricopharyngeal bar, these conditions often occur together and can compound swallowing difficulties.
Pharyngoesophageal Segment Abnormalities
The pharyngoesophageal segment is the transition zone between the throat and esophagus where the cricopharyngeal muscle is located. Abnormalities in this area can significantly impact swallowing function and quality of life.
Radiologists typically note this when there are coordination problems between the pharynx, which is the throat area, and the esophagus. The normal swallowing process requires precise timing, with the pharynx contracting to push food downward just as the cricopharyngeal muscle relaxes to allow passage into the esophagus.
When this timing is off, patients may experience what feels like a traffic jam in their throat. Food gets backed up in the pharynx while waiting for the cricopharyngeal muscle to open, leading to the uncomfortable sensations and swallowing difficulties that bring patients to seek medical attention.
Barium Swallow Test Results
A barium swallow test provides detailed information about how the cricopharyngeal bar affects swallowing function. During this test, patients swallow different consistencies of barium contrast while X-ray images are taken in real-time. This allows doctors to see exactly how food and liquids move through the throat and into the esophagus.
The test typically shows delayed opening of the cricopharyngeal muscle, with contrast material pooling above the bar before eventually passing through. In some cases, contrast may spill over into the airway, indicating an increased risk of aspiration.
The severity of the cricopharyngeal bar can be graded based on how much it narrows the esophageal opening and how significantly it delays the passage of contrast material. This information helps doctors determine the most appropriate treatment approach.
Treatment Options for Cricopharyngeal Bar
Treatment for cricopharyngeal bar depends on the severity of symptoms and the underlying cause. Many patients benefit from swallowing therapy with a speech-language pathologist who specializes in dysphagia. These professionals can teach exercises and techniques to improve swallowing coordination and safety.
Dietary modifications often help manage symptoms. Adjusting food textures, eating smaller bites, and using specific swallowing techniques can make meals more comfortable and safer. Some patients find that avoiding certain problematic foods allows them to maintain adequate nutrition without significant difficulty.
For more severe cases, medical procedures may be necessary. Cricopharyngeal myotomy, a surgical procedure that cuts the tight muscle fibers, can provide relief for patients with significant symptoms. This procedure can be performed through traditional open surgery or newer minimally invasive techniques.
Botulinum toxin injections represent another treatment option for some patients. These injections temporarily weaken the overactive muscle, allowing better coordination during swallowing. The effects typically last several months, and the procedure can be repeated if beneficial.
When to Seek Medical Attention
Anyone experiencing persistent swallowing difficulties should seek medical evaluation. Warning signs that require prompt attention include frequent choking episodes, unintentional weight loss, recurring pneumonia, or complete inability to swallow certain foods or liquids.
Early evaluation and treatment can prevent complications and improve quality of life. A cricopharyngeal bar identified on imaging studies provides valuable information that can guide appropriate treatment decisions and help patients return to more comfortable eating and drinking.
Conclusion
The presence of a cricopharyngeal bar on your radiology report doesn’t necessarily mean you need immediate surgery or that you have a serious medical condition. Many people with this finding can manage their symptoms effectively with conservative treatments and lifestyle modifications. Working closely with your healthcare team, including speech therapists and gastroenterologists when appropriate, can help you develop a comprehensive approach to managing this condition and maintaining good nutrition and swallowing safety.
References
- UCLA Health Esophageal Health Center. “Cricopharyngeal Bar.” UCLA Health, 2024. https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/cricopharyngeal-bar
- Sharma SC, Sakthivel P, et al. “Cricopharyngeal bar.” Pan African Medical Journal, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660909/
- Radiopaedia.org. “Cricopharyngeal bar – Radiology Reference Article.” Radiopaedia, 2024. https://radiopaedia.org/articles/cricopharyngeal-bar