Diagnosis and management of abelchia or R-CPD: a scoping review

Abelchia, more recently termed retrograde cricopharyngeal dysfunction (R-CPD) is characterized by the inability to belch, excessive flatulence, bloating, chest pain, and socially distressing gurgling sounds.This scoping review synthesizes current literature on R-CPD, focusing on its clinical impact, diagnostic modalities, and treatment options.A systematic search across PubMed, Scopus, and Web of Science yielded 353 texts, and after removing duplicates and assessing eligibility, 29 publications were analyzed.Key findings of our review include the following: (1) R-CPD is associated with significant reduction in quality of life (QoL) with social isolation, anxiety, and depression more commonly reported;(2) diagnosis primarily relies on clinical evaluation supported by diagnostic tests particularly high-resolution esophageal manometry (HREM) and belching provocation with characteristics oscillating abnormalities in the upper esophageal sphincter (UES); and (3) botulinum toxin injection into the cricopharyngeal muscle is the most-evidenced first-line treatment, achieving symptom resolution in 80-90% of patients and have durable effects.Surgical myotomy is reserved for refractory cases, and non-invasive approach, such as hypnosis, shows promise but lack robust evidence.In conclusion, abelchia or R-CPD has a significant impact on QoL, and diagnosis relies on clinical evaluation supported by tests like HREM.First line therapy is often botulinum toxin injection into the cricopharyngeus muscle.R-CPD represents a significant yet overlooked condition warranting further clinical and research attention.