Can't Burp? Finding Relief for a Rare but Distressing Disorder
February 03, 2025

For most people, expelling gas through burping – after drinking a fizzy drink, for example – is something they do without even thinking about it. But what if you weren’t able to burp at all? This condition is called retrograde cricopharyngeus dysfunction (RCPD), known informally as no-burp syndrome.
While the condition itself isn’t new, it wasn’t until 2019 that a study named the condition and described its symptoms. What used to be something people suffered from in silence is now trending on social media. There’s also a simple yet effective treatment option to help people with the syndrome find relief.
What Causes No-Burp Syndrome?
RCPD is caused by spasm of the cricopharyngeus muscle, which is located at the top of the esophagus, says N. Scott Howard, MD, Director of the University Hospitals Voice, Airway and Swallowing Center.
When a person swallows, the cricopharyngeus muscle receives a signal to relax, allowing food and liquid to pass into the esophagus on the way to the stomach. After food passes through, the muscle tightens to seal off the top of the esophagus. When swallowed air needs to come back up, this same muscle must relax to allow the gas out as a burp.
With RCPD, while the cricopharyngeus muscle relaxes to let food, beverages and air in, it fails to relax to let any air back out. This traps excess air in the digestive tract, causing symptoms such as bloating, pressure, gurgling sounds in the neck and chest, increased flatulence and significant discomfort or pain. Some patients also report suffering from social anxiety or embarrassment due to the audible gurgling sounds the excess air creates.
Seeking Help for No-Burp Syndrome
Since the disorder was only recently recognized, doctors aren’t sure exactly how common RCPD is, though it appears to be relatively rare. It’s also possible that many people who suffer from it have only mild symptoms, so they don’t seek help.
However, if you’re experiencing significant symptoms that cause physical and mental distress, it’s important to speak with your healthcare provider, says Dr. Howard. They may refer you to an otolaryngologist/head and neck surgeon who specialized in swallowing disorders for further examination. A specialist will listen to your symptoms, discuss your medical history, and determine if additional testing is needed.
While there is no definitive diagnostic test for RCPD, swallowing studies and other tests may be considered to help rule out other conditions. If you have never been able to burp, and have normal swallowing, RCPD is the most likely diagnosis.
Finding Relief with Botox
The primary treatment for no-burp syndrome is botulinum toxin injections, more commonly known as Botox, into the cricopharyngeus muscle. Botox, which has various therapeutic applications, works by paralyzing muscles when given in small doses.
When Botox is injected into the cricopharyngeus muscle, it helps the muscle relax and prevents it from tightening when air needs to be released. The outpatient procedure is performed under general anesthesia and only takes about 15 minutes. The Botox is administered through the mouth using a special scope that goes into the esophagus.
The majority of patients are able to burp and find relief from symptoms within a few days of the Botox treatment. Dr. Howard says that nearly half of people will require a second injection since the effects of Botox wear off after several months, but most patients will continue to burp normally even without additional injections.
For people who do not respond as well to Botox, a procedure called a laser cricopharyngeal myotomy may be performed. This is a minimally invasive endoscopic procedure in which the surgeon makes a small incision that permanently relaxes the cricopharyngeus muscle.
These treatments can be life-changing for many patients, providing them with fast and long-lasting relief from the symptoms of RCPD.
“The increased awareness of RCPD through social media has led to more people finally finding a doctor to help them gain some relief from symptoms that may have plagued them for years,” says Dr. Howard. “This is a great example of the positive role the internet can play in helping inform people about important health topics to improve their quality of life.”
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