Hello I'm Robert Bastian of Laryngopedia and Bastian Voice Institute. By now you are
probably very well educated about the condition we call R-CPD, Retrograde Cricopharyngis Dysfunction,
and in case not, please feel free to go to Laryngopedia and just type in R-CPD
and up comes a resource page with a tremendous amount of information to further educate you.
My purpose today though is to talk to you about the
visual explanation for this terrible disorder. And here we see three x-rays and those three
x-rays really explain why it is that people have severe daily misery from this terrible affliction.
Now these are three people who are in exaggerated level of misery and that's why they went to
an emergency room. The first two are in terrible distress, the third though is in crisis, and I want
to explain the difference, but let's look first at this first x-ray, just to orient you. I'm drawing
a horizontal line here across the upper part of this massive air bubble in the stomach. Above
the line that I'm drawing is what the size of a normal air bubble should be. In this case, there's
this massive amount of air in the stomach. It is so large that it's even depressing the transverse
colon that you can see is also filled with air here, and then you see a huge amount of air in
the descending colon that's ready to emerge as flatulence. So this person's x-ray explains the
severe daily misery; the flatulence, the abdominal bloating, the abdominal distention in many
people, and the gurgling sounds as the abdomen and GI-tract try to to get rid of that air upwards
against an unyielding sphincter. So there in one picture is the explanation for the misery.
The middle picture I'm showing just because it's such a nice view of the elevated hemi-diaphragm
on the left right of photo. And that explains why some people who are very symptomatic say,
"I couldn't possibly go for a run, I just can't fill, I can't get enough
air in," because the the diaphragm is lifted and they can't fill the chest as well. Now let's go to
the third photo. Here's the man who's in an absolute crisis. What happened to him? hHe's
30-something, he's had R-CPD all his life, he's never remembered being able to burp, but it became an
issue in his late teens or early 20s—I forgot when, that's a common story, where he began to have the
the real symptoms. Never could burp, but now he's really uncomfortable. So he's lived with this
on a daily basis for years. Part of the picture for him is that he is constipated,
and so this is taken on a day when he was very constipated and he said okay, took a lot of water,
drank a lot of water, thinking that might get something going. That didn't work and so then,
he did the wrong thing: he took a powerful laxative that is carbonated, it's called magnesium citrate.
So he just blew up his stomach massively here with his air. Why is he in crisis? Well remember, he's
constipated so he's not really able to pass gas, but also look at how part of his
small and large intestines are sequestered way up here to the right by this massive
air bubble in the stomach, and then the rest of his GI-tract is kind of sequestered down here.
All of it filled with air, and here you see the air wanting to get out but being blocked. And so
now, not only can't he burp, but he can't pass gas and he's in true misery. The solution? In the emergency
room, a nasal gastric tube down into the stomach relieve all that air, the GI contents reconfigure,
get the constipation taken care of. Now he can again pass gas and he's back to his sort of normal
daily level of misery, and not this crisis level of misery. Well, when I do a video like this, I'm
always thinking about that individual out there who's anxious and worried about that this is,
this is going to happen to me. Well the answer is no, it's not going to happen to you as long as you
don't do the wrong thing: get very constipated and then fill yourself with carbonation. Just don't do
those two things and you will be, you will not get into this kind of a crisis. So R-CPD, very treatable,
there is a solution. So educate yourself, additionally. Thank you for watching this video!