The inability to burp, a common source of discomfort, is a recognized medical condition. It can significantly impact daily life, causing unpleasant physical sensations.
The Medical Term and Its Symptoms
The medical term for the inability to burp is Retrograde Cricopharyngeal Dysfunction (R-CPD). This condition occurs when the cricopharyngeus muscle, a ring-shaped muscle at the top of the esophagus, fails to relax properly. Normally, this muscle opens to allow air to exit the stomach and esophagus, but in R-CPD, it remains constricted.
Individuals with R-CPD experience various symptoms due to trapped air. Loud gurgling noises from the throat or chest are common, often audible to others, along with abdominal bloating and discomfort, sometimes leading to visible distension. Since air cannot be released through burping, it often passes through the intestines, resulting in excessive flatulence. Other symptoms include nausea, chest pressure, and difficulty vomiting, which can lead to social anxiety and avoidance of certain foods or drinks.
Why You Can’t Burp
The physiological basis of R-CPD lies in the dysfunction of the cricopharyngeus muscle, also known as the upper esophageal sphincter (UES). This muscle is usually contracted, closing off the esophagus entrance. When a person swallows, the cricopharyngeus muscle momentarily relaxes, allowing food and liquid to pass. However, for burping, this same muscle needs to relax and open to release trapped air from the esophagus and stomach. In R-CPD, this reflex relaxation does not happen, so air remains trapped, leading to pressure buildup in the esophagus and stomach, causing characteristic symptoms; while the exact reason for this muscle’s failure to relax is not fully understood, it is believed to be related to abnormal muscle tone.
Finding Relief
Diagnosing R-CPD involves reviewing medical history and symptoms, along with a physical examination that may include flexible nasopharyngoscopy. A Botox injection into the cricopharyngeus muscle can serve as both a diagnostic tool and a treatment, confirming the condition if symptoms improve. The main treatment for R-CPD is a Botox (botulinum toxin) injection into the cricopharyngeus muscle, which temporarily relaxes it, allowing trapped air to be released. This procedure is often performed under general anesthesia, though in-office injections with local anesthesia are also possible, with very high success rates, often over 90% after a single injection. Patients may experience temporary side effects like a feeling of food getting stuck or mild difficulty swallowing for a few weeks; many experience long-term relief despite the temporary nature of Botox effects, with some needing only one injection.