Research progress on botulinum toxin treatment for post-stroke cricopharyngeal achalasia_West China Medical Journal

Authors：

MAO Xin’ao ^1,2 ,  DU Xiaoxia ^1,2

1. School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, P. R. China;
2. Department of Neurorehabilitation, Beijing Bo’ai Hospital, China Rehabilitation Research Centre, Beijing 100068, P. R. China;

Corresponding?author：

DU Xiaoxia, Email: 364906784@qq.com

Keywords：

Botulinum toxin; stroke; cricopharyngeal achalasia; dysphagia; research progress

DOI：

10.7507/1002-0179.202505048

Video：

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Post-stroke cricopharyngeal achalasia is a common swallowing disorder that significantly impacts patients’ quality of life. Traditional treatments have limited efficacy, and in recent years, botulinum toxin injections have gained widespread application due to their therapeutic effects. This method involves local injection to relax the cricopharyngeal muscle, improving swallowing function while enhancing safety and comfort, with relatively long-lasting efficacy. However, current practices lack standardised procedures and precise targeting. Future efforts should focus on optimising treatment protocols to enhance efficacy and reduce adverse reactions. This article reviews the current state of research on botulinum toxin treatment for post-stroke cricopharyngeal achalasia, with the aim of providing a basis for standardised treatment in the future.

Citation： MAO Xin’ao, DU Xiaoxia. Research progress on botulinum toxin treatment for post-stroke cricopharyngeal achalasia. West China Medical Journal, 2025, 40(7): 1166-1170. doi: 10.7507/1002-0179.202505048 Copy

1.	惠艷娉, 席悅, 張巧俊. 腦卒中康復治療進展. 華西醫學, 2018, 33(10): 1295-1302.
2.	王隴德, 彭斌, 張鴻祺, 等. 《中國腦卒中防治報告 2020》概要. 中國腦血管病雜志, 2022, 19(2): 136-144.
3.	肖衛紅, 吳碧玉. 腦卒中后吞咽障礙的康復研究進展. 中國康復理論與實踐, 2017, 23(7): 783-787.
4.	張祎辰, 高正玉, 王強, 等. 環咽肌失弛緩癥的研究進展. 中國康復理論與實踐, 2020, 26(3): 339-343.
5.	Sivarao DV, Goyal RK. Functional anatomy and physiology of the upper esophageal sphincter. Am J Med, 2000, 108(Suppl 4): 27S-37S.
6.	何容, 郭艷芹, 王懷林, 等. 環咽肌失弛緩的診斷與治療發展現狀. 牡丹江醫學院學報, 2012, 33(4): 50-52.
7.	許時良, 陳慧珍, 鄧行行, 等. 環咽肌失弛緩所致吞咽障礙的治療研究進展. 海南醫學, 2014, 25(15): 2264-2265.
8.	俞茗文, 萬萍. 腦損傷后咽期吞咽障礙的康復治療研究進展. 中國康復, 2017, 32(6): 518-521.
9.	Cook IJ. Cricopharyngeal function and dysfunction. Dysphagia, 1993, 8(3): 244-251.
10.	Krekeler BN, Howell RJ. Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment. Eur Arch Otorhinolaryngol, 2024, 281(9): 4519-4527.
11.	葉婷, 張雪平. 肉毒毒素作用機制的研究進展. 微生物學免疫學進展, 2017, 45(2): 89-96.
12.	Blitzer A, Sulica L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope, 2001, 111(2): 218-226.
13.	孫曉佳. 肉毒素在喉科的臨床應用. 轉化醫學雜志, 2021, 10(2): 126-129.
14.	Kelly EA, Koszewski IJ, Jaradeh SS, et al. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol, 2013, 122(2): 100-108.
15.	田曄, 孫麗娜, 王芹, 等. 球囊擴張術治療環咽肌失弛緩的臨床療效研究. 中國醫學創新, 2019, 16(1): 128-131.
16.	竇祖林, 蘭月, 萬桂芳. 神經性吞咽障礙的康復治療及其進展. 中華物理醫學與康復雜志, 2006(11): 788-791.
17.	Dewan K, Santa Maria C, Noel J. Cricopharyngeal achalasia: management and associated outcomes-a scoping review. Otolaryngol Head Neck Surg, 2020, 163(6): 1109-1113.
18.	Laxague F, Herbella FAM, Schlottmann F. Cricopharyngeal myotomy and toxin botulinum injection for the treatment of upper esophageal sphincter disorders: a narrative review. Ann Esophagus, 2021: 5.
19.	戴萍, 姚新陽, 朱丹, 等. 超聲引導下 A 型肉毒毒素注射治療腦卒中后環咽肌失弛緩癥的效果分析. 現代實用醫學, 2024, 36(8): 1110-1112.
20.	Jung KT, Choi HK, Lee KB, et al. Endoscopic botulinum toxin injection in cricopharyngeal dysphagia. Korean J Med, 2010, 79(3): 301-305.
21.	Kim MS, Kim GW, Rho YS, et al. Office-based electromyography-guided botulinum toxin injection to the cricopharyngeus muscle: optimal patient selection and technique. Ann Otol Rhinol Laryngol, 2017, 126(5): 349-356.
22.	王利春, 黃鳳慧, 苗維, 等. CT 引導下肉毒毒素環咽肌注射治療真性延髓麻痹所致吞咽障礙 1 例報道. 中國康復理論與實踐, 2019, 25(4): 477-480.
23.	Huai J, Hou Y, Guan J, et al. Botulinum toxin A injection using esophageal balloon radiography combined with CT guidance for the treatment of cricopharyngeal dysphagia. Dysphagia, 2020, 35(4): 630-635.
24.	樊留博, 張露丁, 羅咪咪, 等. 導管球囊定位聯合超聲引導下環咽肌 A 型肉毒毒素注射治療環咽肌失弛緩癥吞咽障礙療效觀察. 浙江醫學, 2022, 44(3): 263-268.
25.	劉超, 李元, 譚智, 等. 消化內鏡引導下肉毒毒素注射聯合球囊擴張治療腦干梗死后環咽肌失弛緩的效果. 中南大學學報(醫學版), 2023, 48(8): 1203-1209.
26.	溫紅梅, 萬桂芳, 唐志明, 等. 超聲、球囊聯合肌電引導注射肉毒毒素治療腦卒中后環咽肌失弛緩: 1 例報告. 中國康復醫學雜志, 2019, 34(9): 1088-1091.
27.	Xie M, Zeng P, Wan G, et al. The effect of combined guidance of botulinum toxin injection with ultrasound, catheter balloon, and electromyography on neurogenic cricopharyngeal dysfunction: a prospective study. Dysphagia, 2022, 37(3): 601-611.
28.	Mohajir WA, Khurana S, Singh K, et al. Botulinum toxin a use in the gastrointestinal tract: a reappraisal after three decades. Gastroenterol Hepatol (N Y), 2023, 19(4): 198-212.
29.	中國康復醫學會吞咽障礙康復專業委員會. 中國吞咽障礙康復管理指南(2023 版). 中華物理醫學與康復雜志, 2023, 45(12): 1057-1072.
30.	徐軍, 冀靜. A 型肉毒素的臨床應用. 中國城鄉企業衛生, 2018, 33(12): 42-45.
31.	Gordon MF, Barron R. Effectiveness of repeated treatment with botulinum toxin type A across different conditions. South Med J, 2006, 99(8): 853-861.
32.	Ashman A, Dale OT, Baldwin DL. Management of isolated cricopharyngeal dysfunction: systematic review. J Laryngol Otol, 2016, 130(7): 611-615.
33.	Xie M, Dou Z, Wan G, et al. Design and implementation of botulinum toxin on cricopharyngeal dysfunction guided by a combination of catheter balloon, ultrasound, and electromyography (BECURE) in patients with stroke: study protocol for a randomized, double-blinded, placebo-controlled trial. Trials, 2021, 22(1): 238.

1. 惠艷娉, 席悅, 張巧俊. 腦卒中康復治療進展. 華西醫學, 2018, 33(10): 1295-1302.
2. 王隴德, 彭斌, 張鴻祺, 等. 《中國腦卒中防治報告 2020》概要. 中國腦血管病雜志, 2022, 19(2): 136-144.
3. 肖衛紅, 吳碧玉. 腦卒中后吞咽障礙的康復研究進展. 中國康復理論與實踐, 2017, 23(7): 783-787.
4. 張祎辰, 高正玉, 王強, 等. 環咽肌失弛緩癥的研究進展. 中國康復理論與實踐, 2020, 26(3): 339-343.
5. Sivarao DV, Goyal RK. Functional anatomy and physiology of the upper esophageal sphincter. Am J Med, 2000, 108(Suppl 4): 27S-37S.
6. 何容, 郭艷芹, 王懷林, 等. 環咽肌失弛緩的診斷與治療發展現狀. 牡丹江醫學院學報, 2012, 33(4): 50-52.
7. 許時良, 陳慧珍, 鄧行行, 等. 環咽肌失弛緩所致吞咽障礙的治療研究進展. 海南醫學, 2014, 25(15): 2264-2265.
8. 俞茗文, 萬萍. 腦損傷后咽期吞咽障礙的康復治療研究進展. 中國康復, 2017, 32(6): 518-521.
9. Cook IJ. Cricopharyngeal function and dysfunction. Dysphagia, 1993, 8(3): 244-251.
10. Krekeler BN, Howell RJ. Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment. Eur Arch Otorhinolaryngol, 2024, 281(9): 4519-4527.
11. 葉婷, 張雪平. 肉毒毒素作用機制的研究進展. 微生物學免疫學進展, 2017, 45(2): 89-96.
12. Blitzer A, Sulica L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope, 2001, 111(2): 218-226.
13. 孫曉佳. 肉毒素在喉科的臨床應用. 轉化醫學雜志, 2021, 10(2): 126-129.
14. Kelly EA, Koszewski IJ, Jaradeh SS, et al. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol, 2013, 122(2): 100-108.
15. 田曄, 孫麗娜, 王芹, 等. 球囊擴張術治療環咽肌失弛緩的臨床療效研究. 中國醫學創新, 2019, 16(1): 128-131.
16. 竇祖林, 蘭月, 萬桂芳. 神經性吞咽障礙的康復治療及其進展. 中華物理醫學與康復雜志, 2006(11): 788-791.
17. Dewan K, Santa Maria C, Noel J. Cricopharyngeal achalasia: management and associated outcomes-a scoping review. Otolaryngol Head Neck Surg, 2020, 163(6): 1109-1113.
18. Laxague F, Herbella FAM, Schlottmann F. Cricopharyngeal myotomy and toxin botulinum injection for the treatment of upper esophageal sphincter disorders: a narrative review. Ann Esophagus, 2021: 5.
19. 戴萍, 姚新陽, 朱丹, 等. 超聲引導下 A 型肉毒毒素注射治療腦卒中后環咽肌失弛緩癥的效果分析. 現代實用醫學, 2024, 36(8): 1110-1112.
20. Jung KT, Choi HK, Lee KB, et al. Endoscopic botulinum toxin injection in cricopharyngeal dysphagia. Korean J Med, 2010, 79(3): 301-305.
21. Kim MS, Kim GW, Rho YS, et al. Office-based electromyography-guided botulinum toxin injection to the cricopharyngeus muscle: optimal patient selection and technique. Ann Otol Rhinol Laryngol, 2017, 126(5): 349-356.
22. 王利春, 黃鳳慧, 苗維, 等. CT 引導下肉毒毒素環咽肌注射治療真性延髓麻痹所致吞咽障礙 1 例報道. 中國康復理論與實踐, 2019, 25(4): 477-480.
23. Huai J, Hou Y, Guan J, et al. Botulinum toxin A injection using esophageal balloon radiography combined with CT guidance for the treatment of cricopharyngeal dysphagia. Dysphagia, 2020, 35(4): 630-635.
24. 樊留博, 張露丁, 羅咪咪, 等. 導管球囊定位聯合超聲引導下環咽肌 A 型肉毒毒素注射治療環咽肌失弛緩癥吞咽障礙療效觀察. 浙江醫學, 2022, 44(3): 263-268.
25. 劉超, 李元, 譚智, 等. 消化內鏡引導下肉毒毒素注射聯合球囊擴張治療腦干梗死后環咽肌失弛緩的效果. 中南大學學報(醫學版), 2023, 48(8): 1203-1209.
26. 溫紅梅, 萬桂芳, 唐志明, 等. 超聲、球囊聯合肌電引導注射肉毒毒素治療腦卒中后環咽肌失弛緩: 1 例報告. 中國康復醫學雜志, 2019, 34(9): 1088-1091.
27. Xie M, Zeng P, Wan G, et al. The effect of combined guidance of botulinum toxin injection with ultrasound, catheter balloon, and electromyography on neurogenic cricopharyngeal dysfunction: a prospective study. Dysphagia, 2022, 37(3): 601-611.
28. Mohajir WA, Khurana S, Singh K, et al. Botulinum toxin a use in the gastrointestinal tract: a reappraisal after three decades. Gastroenterol Hepatol (N Y), 2023, 19(4): 198-212.
29. 中國康復醫學會吞咽障礙康復專業委員會. 中國吞咽障礙康復管理指南(2023 版). 中華物理醫學與康復雜志, 2023, 45(12): 1057-1072.
30. 徐軍, 冀靜. A 型肉毒素的臨床應用. 中國城鄉企業衛生, 2018, 33(12): 42-45.
31. Gordon MF, Barron R. Effectiveness of repeated treatment with botulinum toxin type A across different conditions. South Med J, 2006, 99(8): 853-861.
32. Ashman A, Dale OT, Baldwin DL. Management of isolated cricopharyngeal dysfunction: systematic review. J Laryngol Otol, 2016, 130(7): 611-615.
33. Xie M, Dou Z, Wan G, et al. Design and implementation of botulinum toxin on cricopharyngeal dysfunction guided by a combination of catheter balloon, ultrasound, and electromyography (BECURE) in patients with stroke: study protocol for a randomized, double-blinded, placebo-controlled trial. Trials, 2021, 22(1): 238.

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