The cricopharyngeus is a small but important muscle in your throat that acts as a gatekeeper between your throat and your esophagus. It wraps around the top of the esophagus like a ring, staying contracted at rest to keep air out of your digestive tract and food from coming back up. When you swallow, it relaxes for a split second to let food pass through, then snaps shut again. When this muscle doesn’t work properly, it can cause difficulty swallowing, an inability to burp, or a persistent feeling of something stuck in your throat.
Where the Muscle Sits
The cricopharyngeus attaches to the cricoid cartilage, a ring of cartilage at the base of your voice box, and wraps circumferentially around the back of the throat. It forms the main component of what doctors call the upper esophageal sphincter (UES), the muscular valve that separates your throat from your esophagus. At rest, this sphincter maintains a constant squeeze, with pressures typically ranging between 100 and 150 mmHg. It receives nerve signals from both the pharyngeal plexus and the recurrent laryngeal nerve, which coordinate its ability to contract and relax on cue.
How It Works During Swallowing
Every time you swallow, the cricopharyngeus has to open and close in a precisely timed sequence. Three things happen in rapid succession: first, muscles in your throat pull the voice box upward and forward, which mechanically starts to peel open the sphincter. Second, the cricopharyngeus itself actively relaxes. Third, the pressure of the food or liquid passing through stretches it open the rest of the way.
This whole process takes less than a second. Once the food clears into the esophagus, the muscle snaps back to its resting state. That constant tonic contraction serves an important purpose: it prevents you from swallowing air every time you breathe and stops stomach contents from refluxing back up into your throat.
When the Muscle Doesn’t Relax: Swallowing Problems
When the cricopharyngeus fails to relax properly during swallowing, food can feel like it’s getting stuck at the base of the throat. This is sometimes called cricopharyngeal dysfunction or cricopharyngeal achalasia. The muscle essentially stays too tight when it should be opening, forcing the throat to generate extra pressure to push food through.
Over time, that increased pressure can cause a more serious problem. Just above the cricopharyngeus, there’s a naturally weak spot in the throat wall. Years of excessive swallowing pressure can cause the lining to herniate through that weak point, forming a pouch called a Zenker’s diverticulum. Food collects in the pouch, leading to bad breath, regurgitation of undigested food, and worsening difficulty swallowing. The underlying cause is typically fibrotic changes in the cricopharyngeus that make it stiff and less compliant.
The Inability to Burp
A more recently recognized condition called retrograde cricopharyngeal dysfunction (RCPD) involves the same muscle but in the opposite direction. In RCPD, the cricopharyngeus relaxes normally during swallowing (so eating isn’t a problem) but refuses to open when gas needs to travel upward from the stomach and esophagus. The result is a lifelong or near-lifelong inability to burp.
The hallmark symptoms are an inability to belch, abdominal bloating and fullness, gurgling noises in the chest or lower neck (as trapped gas moves around without an exit), and excessive flatulence. Some people also experience chest pressure and pain. Qualitative interviews with RCPD patients found that bloating and the socially awkward gurgling noises cause the most distress, leading to anxiety, social isolation, and missed days at work or school. One theory suggests the muscle’s failure to relax in response to esophageal gas may be a subconsciously learned response to prevent aspiration.
How Problems Are Diagnosed
Diagnosis depends on the type of dysfunction. For swallowing-related problems, a videofluoroscopic swallow study (where you swallow liquid containing barium while being filmed on X-ray) can reveal a “bar” of muscle that doesn’t open. High-resolution manometry, a test that measures pressure along the length of the esophagus using a thin flexible tube passed through the nose, can detect abnormally high sphincter pressures or incomplete relaxation during swallows.
For RCPD, diagnosis is currently based almost entirely on symptoms: the inability to burp combined with bloating, gurgling, and excessive gas, in the absence of any swallowing difficulty. There’s no single lab test or imaging study that confirms it, though the pattern of symptoms is distinctive enough for experienced clinicians to recognize.
Treatment Options
Treatment depends on whether the problem involves swallowing, burping, or both.
For RCPD, the primary treatment is a Botox injection into the cricopharyngeus muscle. A small dose (typically 50 to 75 units) is injected endoscopically during an outpatient procedure. The Botox temporarily weakens the muscle, allowing it to relax when gas pushes upward. In a study of 200 patients treated this way, 99.5% gained the ability to burp and 95% experienced significant relief of all cardinal symptoms: bloating, gurgling, chest pressure, and excessive flatulence. For many patients, the ability to burp persists even after the Botox wears off, suggesting the body “learns” the new pattern.
For swallowing dysfunction, the same Botox approach can be used as a trial to see if weakening the muscle helps. If it does, a more permanent surgical option called cricopharyngeal myotomy may follow. This procedure cuts through the muscle fibers to permanently reduce the sphincter’s resistance. It can be done through an open incision on the neck or endoscopically through the mouth. A comparison of 38 open and 41 endoscopic myotomy patients found the endoscopic approach had shorter operative times and better symptom outcomes, with no difference in complication rates or hospital stays.
Exercises That Can Help
For milder swallowing difficulties related to the upper esophageal sphincter, a rehabilitative exercise called the Shaker maneuver can strengthen the muscles responsible for pulling the sphincter open. You lie flat on your back without a pillow and lift only your head to look at your feet, as if holding a tennis ball under your chin. The protocol involves three 60-second sustained lifts with 60 seconds of rest between each, followed by 30 quick repetitive lifts. This targets the strap muscles in the front of the neck that pull the voice box upward during swallowing, which in turn helps the cricopharyngeus open more fully. For people who find lying flat too uncomfortable, a seated version using a rolled towel squeezed under the chin can provide a similar workout.