Why Can’t I Burp? Retrograde Cricopharyngeus Dysfunction (R-CPD) Symptoms and Treatment
Struggling to burp isn’t just a weird quirk — it’s a medical condition known as retrograde cricopharyngeus dysfunction (R-CPD). Also called abelchia, it can lead to uncomfortable and awkward symptoms like audible gurgling in the chest and excessive flatulence.
So-called “no-burp syndrome” is pretty rare, but people are talking about it a lot more in recent years thanks in large part to an active patient community on Reddit that’s 32,000 strong and growing, says Lee Akst, MD, an associate professor and director of laryngology at the Johns Hopkins School of Medicine in Baltimore.
“No one really knows, to my knowledge, how common it is, because until recently, we didn’t recognize it as something that could be treated, and there aren’t large scale population studies about it,” Dr. Akst says.
No-burp syndrome happens when the cricopharyngeus muscle, a sphincter muscle near the top of the esophagus, can’t relax properly to open and let air escape, Akst says. This cuts off one exit route for gas leaving the stomach, causing gurgling in the neck and chest as gas gets trapped, which leads to bloating and flatulence as gas travels the other way through the digestive tract. Most noticeably, this makes it difficult if not impossible for people to burp.
“While we know what is happening to cause the phenomenon — the cricopharyngeus muscle isn’t relaxing when gas leaves the stomach and enters the esophagus — I don’t think we know why,” Akst says.
Common Symptoms of No-Burp Syndrome
There are no hard and fast rules when it comes to how much people should burp, but everyone needs to do it sometimes to release gas that builds up in the stomach during digestion, says Robert Bastian, MD, a laryngologist at the Bastian Voice Institute outside Chicago in Downers Grove, Illinois.
“Some just burp a few times, such as once after each meal,” Dr. Bastian says. “Others burp quite a lot. Some say ‘I don’t burp’ because they pay no attention and it is below their consciousness, but if they then become mindful of burping, they realize they do burp.”
But then there are the people with no-burp syndrome, who have no memory of ever burping, or find they get no relief from the very infrequent occasions when they are able to burp, Bastian says.
- Never burping, ever, for as long as you can remember
- Bloating
- Gurgling sounds in the throat
- Flatulence
These are lifelong symptoms that happen all the time. People who have one night of discomfort directly related to something they ate don’t have no-burp syndrome.
How to Diagnose No-Burp Syndrome
In an initial physical exam, doctors will often perform a flexible nasopharyngoscopy, which entails inserting a thin tube with a light and camera through the mouth or nose and down into the throat and upper esophagus.
To confirm the diagnosis, doctors typically will inject Botox into the cricopharyngeus muscle. This should relax the muscle and allow people to burp and relieve their symptoms, making Botox an effective diagnostic tool.
The procedure can be done in an operating room under general anesthesia, using a procedure known as upper esophagoscopy to guide a device into the esophagus. Or it can be done awake in a doctor’s office, using electrodes on the neck and a special needle with electrodes as guides.
How to Treat No-Burp Syndrome
Botox can be used to both diagnose and treat no-burp syndrome. In many cases, people can get lasting relief with a single injection, says Hayley Born, MD, a laryngologist and an assistant professor at the Center for Voice and Swallowing at Columbia University Irving Medical Center in New York City.
Botox wears off within three to four months. “But somewhat surprisingly, the majority of patients only require one injection of Botox to cure their retrograde cricopharyngeus dysfunction,” Dr. Born says.
Some patients do require a second or third injection, Born says. “If the injections are not long-lasting after several attempts, we can consider actually cutting the muscle (cricopharyngeal myotomy). However this is done with caution, as it is irreversible.”
Risks of No-Burp Syndrome
Left untreated, no-burp syndrome can lead to severe chest pain from stretching in the esophagus, Bastian says. It can also cause a frequent gagging sensation and constipation.
Symptoms contribute to poor mood and embarrassment. “Many feel that people next to them can hear the gurgling and that causes distress,” Akst says.
The physical and emotional discomfort can make social situations difficult. “I had a patient tell me he went to a family wedding where it was really hot during the ceremony,” Akst recalls. “As soon as he got into the reception he had a soft drink to cool down, and was immediately so bloated and uncomfortable from the carbonation that he had to leave the party early.”
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