title: Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease.
abstract: BACKGROUND
  A cricopharyngeal bar seen on barium fluoroscopy has been shown to be related to the presence of gastroesophageal reflux (GER). We investigated premature contraction of the cricopharyngeus (PCC) muscle, which may be a precursor of a fixed cricopharyngeal bar, to assess its significance in GER.
  
  
  METHODS
  The prevalence of PCC on barium swallow was recorded in three groups: (1) 83 patients with non-cardiac chest pain who were investigated for possible GER; (2) 21 patients with severe GER undergoing fundoplication; and (3) 25 normal controls.
  
  
  RESULTS
  Group 1: PCC was observed in 42 of 77 with documented GER (54.5%), and in two of six patients without GER. Group 2: PCC was present in 11 of 21 fundoplication subjects. Group 3: PCC was seen in five of 25 normal controls. The incidence of PCC in patients with GER was statistically significantly higher than in normal subjects (p = 0.002). The sensitivity of the presence of PCC as a predictor of GER is only 0.54, but the specificity is 0.774, with a positive predictive value of 0.883.
  
  
  CONCLUSIONS
  We conclude that observing premature cricopharyngeal contraction during the first swallows of an upper gastrointestinal (GI) study should direct attention to the possibility of GER.
authors.affiliation: Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
authors.forename: A P
authors.initials: AP
authors.lastname: Brady
authors.forename: G W
authors.initials: GW
authors.lastname: Stevenson
authors.forename: S
authors.initials: S
authors.lastname: Somers
authors.forename: D M
authors.initials: DM
authors.lastname: Hough
authors.forename: E
authors.initials: E
authors.lastname: Di Giandomenico
mesh_terms: D001466:Barium Sulfate; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology*; D010609:Pharyngeal Muscles / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D014743:Videotape Recording
chemical_list: D001466:Barium Sulfate