Retrograde Cricopharyngeal Dysfunction (Inability to Burp)
Retrograde cricopharyngeal dysfunction (R-CPD), sometimes called no-burp syndrome, is a condition in which a person is unable to burp. It happens when the cricopharyngeus muscle, the ring of muscle at the top of the gullet, fails to relax to let trapped air escape upwards from the oesophagus. Because the air cannot come back up as a burp, it builds up and causes a characteristic set of symptoms.
R-CPD is only relatively recently recognised, and many people have lived with it for years without a diagnosis. The good news is that it is very treatable. As a laryngologist with expertise in the cricopharyngeus muscle, I am able to diagnose R-CPD and offer effective treatment.
Symptoms of R-CPD
- An inability to burp, often lifelong
- Uncomfortable bloating and pressure in the chest, throat or upper abdomen, typically worse after eating or drinking
- Loud gurgling or croaking noises from the lower throat and chest, which others can often hear
- Excessive and sometimes socially difficult flatulence
- Nausea and a feeling of being unable to relieve the trapped air
- Symptoms that are often worse after fizzy drinks, beer or large meals
How I diagnose R-CPD
R-CPD is largely diagnosed from the characteristic history of being unable to burp combined with bloating and gurgling. At your consultation I will take a careful history and examine your throat and voice box with a thin flexible camera (nasendoscopy) to assess the area and exclude other causes of your symptoms. The combination of typical symptoms and examination usually makes the diagnosis clear.
Treatment: Botox injection to the cricopharyngeus muscle
The established treatment for R-CPD is an injection of botulinum toxin (Botox) into the cricopharyngeus muscle.
The Botox temporarily relaxes and weakens the muscle so that, often for the first time, trapped air can escape upward as a burp.
The procedure is usually carried out under a brief general anaesthetic, which allows the muscle to be injected precisely through an endoscope, although in selected cases it can be performed using EMG guidance.
The results are typically very good. The great majority of patients are able to burp after treatment and experience a substantial improvement in bloating, gurgling and discomfort. Although the Botox itself wears off over a few months, many people continue to be able to burp once the reflex has been re-established, so for a large proportion of patients a single treatment provides a lasting cure. If symptoms return, the injection can be repeated.
What to expect after treatment
In the first few weeks after the injection you may notice new burping, some changes in swallowing and occasionally a temporary sensation of food sticking, which settles as the Botox effect eases. I will give you clear aftercare advice and arrange follow-up to assess your response and discuss whether any further treatment is needed.
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FAQs
How do I know if I have R-CPD?
The hallmark of R-CPD is being unable to burp, usually lifelong, together with bloating, audible gurgling from the lower throat or chest, and excessive flatulence. If these symptoms sound familiar, a specialist assessment can confirm the diagnosis and discuss treatment. Many people are relieved to learn their long-standing symptoms have a recognised cause.
How effective is Botox treatment for R-CPD?
Botox injection into the cricopharyngeus muscle is highly effective. The large majority of patients are able to burp afterwards and report a major reduction in bloating and gurgling. For many, the ability to burp continues even after the Botox wears off, so a single treatment is often curative. The injection can be repeated if needed.
Is the procedure done while I am awake or asleep?
The injection is usually performed under a short general anaesthetic, which allows the muscle to be injected precisely through an endoscope. In selected cases an awake, EMG-guided approach may be possible. I will discuss the most suitable approach for you.
Will the inability to burp come back?
For a large proportion of patients the ability to burp is maintained even after the Botox effect fades, giving a long-lasting result. In some people symptoms gradually return, in which case a repeat injection is straightforward and effective.