It can be a puzzling and uncomfortable experience to feel trapped air in your chest and abdomen without the relief of a burp. While burping is a common bodily function that most people take for granted, its absence can lead to noticeable distress. This article explores the normal process of burping, the reasons why some people cannot burp, the symptoms that arise from this inability, and the available treatment options.
How Burping Works
Burping is the body’s natural way of expelling excess gas from the upper digestive tract. When you eat or drink, you inevitably swallow some air, which accumulates in the stomach and esophagus.
The primary muscle involved in releasing this trapped air is the cricopharyngeal muscle, located at the top of the esophagus. This muscle acts as a sphincter, normally remaining closed to prevent stomach contents from re-entering the throat. When enough air builds up, the esophagus distends, triggering a reflex that causes the cricopharyngeal muscle to relax and open. This relaxation allows the accumulated air to escape upwards through the throat and out of the mouth, resulting in a burp.
Primary Reasons for Not Burping
The inability to burp is most commonly attributed to a condition called Retrograde Cricopharyngeal Dysfunction (R-CPD). In individuals with R-CPD, the cricopharyngeal muscle fails to relax adequately to allow air to escape upwards from the esophagus and stomach. This means that while the muscle can relax to allow food and liquids to pass downwards into the esophagus during swallowing, it does not open sufficiently in the opposite direction for belching.
The exact cause of why the cricopharyngeal muscle does not relax retrogradely in R-CPD patients is not fully understood. Some researchers hypothesize it might be an issue with abnormal muscle tone or a learned behavior. While R-CPD is the main reason for the inability to burp, other factors like excessive air swallowing, known as aerophagia, can exacerbate the problem by introducing more gas. Certain gastrointestinal conditions may also contribute to or mimic the symptoms, but R-CPD specifically addresses the mechanical inability of the muscle to allow air release.
Accompanying Symptoms and Daily Impact
When an individual cannot burp, the excess air that would normally be expelled accumulates in the stomach, esophagus, and intestines. This trapped gas leads to a range of uncomfortable symptoms. Common complaints include severe abdominal bloating and a feeling of fullness.
The inability to release gas also results in gurgling noises emanating from the chest and throat. Many individuals experience abdominal pain, chest pressure, and excessive flatulence. Nausea and difficulty vomiting are also reported by some people with this condition. These symptoms can significantly impact a person’s quality of life, leading to social anxiety and avoidance of certain foods or drinks, such as carbonated beverages, which worsen the discomfort.
When to Seek Medical Help and Treatment Options
If you consistently experience the inability to burp along with accompanying symptoms like severe bloating, gurgling noises, or abdominal discomfort, consult a healthcare professional. A doctor will begin with a thorough clinical assessment, reviewing your medical history and performing a physical examination. While R-CPD is primarily diagnosed based on these symptoms, additional tests like a barium swallow study, manometry to measure esophageal pressure, or endoscopy may be conducted to rule out other gastrointestinal conditions or structural abnormalities.
The primary treatment for Retrograde Cricopharyngeal Dysfunction is a Botox (botulinum toxin) injection into the cricopharyngeal muscle. This procedure temporarily relaxes the muscle, allowing the trapped air to escape and enabling the patient to burp. The injection is performed under general anesthesia, or in-office with local anesthesia, and success rates for achieving the ability to burp are high. While the effects of Botox last several months, many patients experience long-term relief even after the medication wears off, suggesting a potential “relearning” of the burping reflex. For those who do not achieve sustained relief from a single injection, a second injection may be considered, or in rare cases, a partial cricopharyngeal myotomy, which is a surgical procedure to partially cut the muscle, may be performed for permanent treatment.