Can't burp? How retrograde cricopharyngeal dysfunction is treated

Retrograde cricopharyngeal dysfunction (R-CPD) is a condition that impairs the ability to burp due to an overly tight cricopharyngeal muscle, which is located in the upper oesophageal sphincter. This rare condition can lead to discomfort from trapped gas, bloating, chest pain and social embarrassment.

While burping is a simple reflex for most, those with R-CPD cannot release gas from the stomach through the oesophagus. Understanding the symptoms, diagnosis, and available treatments can help manage this condition effectively.

What causes retrograde cricopharyngeal dysfunction?

The exact cause of R-CPD remains unclear, but the condition involves a failure of the cricopharyngeal muscle to relax appropriately, preventing the release of swallowed air. It is often linked to:

• Abnormal muscle tone in the upper oesophageal sphincter.
• Neurological conditions or muscular disorders (although these are rare).
• Psychological factors such as heightened sensitivity to bodily functions in some individuals.

What are the symptoms of R-CPD?

Common symptoms include:

• Inability to burp.
• Persistent bloating or abdominal discomfort, especially after eating or drinking.
• Audible gurgling noises in the throat or chest.
• A sensation of pressure in the chest or throat.
• Excessive flatulence due to gas being redirected to the intestines.

These symptoms can cause significant discomfort and distress, leading to dietary restrictions or lifestyle changes.

How is R-CPD diagnosed?

Diagnosis begins with a detailed medical history and physical examination. Physicians may also use the following diagnostic tools:

• Barium swallow study: To observe the function of the oesophagus and cricopharyngeal muscle.
• Manometry: To measure the pressure in the upper oesophageal sphincter.
• Endoscopy: To rule out other conditions such as structural abnormalities or oesophageal disorders.

How is retrograde cricopharyngeal dysfunction treated?

Treatment options focus on relaxing the cricopharyngeal muscle or addressing the underlying dysfunction. Common treatments include:

Botulinum toxin (Botox) injections

• A widely used and effective treatment, Botox ™ is injected into the cricopharyngeal muscle to temporarily relax it, allowing gas to escape.
• Results typically last several months, and the procedure can be repeated if necessary.

Swallowing therapy

• Working with a speech and swallowing therapist can help strengthen surrounding muscles and teach techniques to manage symptoms.

Balloon dilation

• A minimally invasive procedure where a balloon is inserted into the oesophagus and inflated to stretch the cricopharyngeal muscle.

Myotomy

• For severe or persistent cases, surgical intervention involves cutting the cricopharyngeal muscle to permanently alleviate the obstruction. This procedure is typically reserved for those who have not responded to less invasive options.

R-CPD is a challenging but manageable condition. Advances in treatments, including Botox and minimally invasive techniques, offer effective solutions for patients struggling with the inability to burp. If you suspect R-CPD, consulting with an ENT specialist or gastroenterologist is essential for accurate diagnosis and personalised treatment to improve comfort and quality of life.