For some individuals, the simple act of burping remains elusive. This can lead to persistent discomfort and challenging social situations. While often misunderstood, the inability to burp is a recognized medical condition that significantly impacts daily life.
What It Means to Not Be Able to Burp
The condition characterized by an inability to burp is medically termed Retrograde Cricopharyngeus Dysfunction (R-CPD). It involves a disruption in the body’s normal process of releasing swallowed air. Ordinarily, when excess air accumulates in the stomach and esophagus, a reflex triggers the release of this gas upwards through the mouth.
In R-CPD, air becomes trapped because it cannot be expelled from the esophagus and stomach. This results in a buildup of gas, which can then travel further into the digestive system.
Common Signs and Discomforts
The inability to burp leads to a range of symptoms. A primary complaint is significant abdominal bloating and discomfort, which can worsen after eating or drinking. This trapped air can cause the abdomen to distend, sometimes making individuals appear visibly pregnant.
Many people with R-CPD experience loud gurgling noises from their chest and throat as air attempts to escape but is blocked. These sounds can be uncontrollable and socially embarrassing, leading to anxiety and avoidance of social gatherings or public eating. Other symptoms include excessive flatulence, a sensation of pressure in the chest or throat, nausea, difficulty vomiting, or painful hiccups.
The Underlying Reason
The cause of R-CPD centers on the cricopharyngeus muscle, also known as the upper esophageal sphincter. This muscle forms a ring at the top of the esophagus, acting as a valve between the throat and the food pipe. It normally remains tightly closed, preventing stomach contents from flowing back up.
When swallowing, the cricopharyngeus muscle relaxes briefly to allow passage into the esophagus. For burping to occur, this same muscle must relax to permit the upward release of gas. In R-CPD, the cricopharyngeus muscle fails to relax appropriately during periods of esophageal distension from trapped gas. This ongoing tightness of the muscle traps air, leading to the symptoms.
Diagnosis and Treatment Options
Diagnosing R-CPD involves reviewing a patient’s medical history and symptoms. While diagnostic tests like barium swallow studies or manometry might show some changes, the absence of abnormalities does not rule out the condition. The diagnosis is often clinical, based on the symptoms.
The main treatment for R-CPD involves injecting Botulinum Toxin (Botox) into the cricopharyngeus muscle. This temporarily relaxes the overly tight muscle, allowing gas to escape and enabling the patient to burp. The injection can be performed under general anesthesia with endoscope guidance, or in an outpatient setting using electromyography (EMG) guidance.
Most patients experience symptom relief and the ability to burp within a week after a single Botox injection. Success rates are high, with studies reporting over 99% of patients gaining the ability to burp and 95% experiencing symptom relief. While Botox effects typically last around three months, many patients find the ability to burp persists even after the medication wears off, with approximately 80% experiencing long-term relief after one injection. Patients who do not achieve lasting relief from the initial injection may receive a second injection, or in rare cases, a surgical procedure called a partial cricopharyngeal myotomy might be considered.