Think You Have No-Burp Syndrome? Here’s What We Know About This Rare Condition

When you’ve just had a filling meal or chugged a can of soda, all that pressure building up in your stomach can usually be relieved by a burp or belch.

But if you have retrograde cricopharyngeus dysfunction (RCPD), or no-burp syndrome, you can’t burp. While RCPD isn’t serious, some of its symptoms may make you feel self-conscious and affect your quality of life.

What is RCPD?

People who have RCPD — a rare condition — physically can’t burp or belch.

Burping is a natural function, says gastroenterologist Alison Schneider, MD. It’s how your body gets rid of the excess air that ends up in your stomach when you swallow food.

“When you can’t burp, air builds up in your esophagus and stomach,” explains Dr. Schneider. “That can cause symptoms like chest pain, farting more than usual and a swollen abdomen.”

It’s hard to say how many people have RCPD. In 2019, a study described symptoms and successful RCPD treatment for 51 people. Since then, more people are seeking treatment because they read about RCPD on social media platforms.

RCPD symptoms

Air trapped in your esophagus and stomach may cause symptoms like:

• Abdominal swelling
• Severe abdominal pain that may be worse right after you eat
• Chest pain
• Difficulty vomiting
• Farting a lot
• Loud gurgling noises that come from your chest and lower neck
• Nausea

RCPD symptoms can greatly impact your quality of life. It can make you feel self-conscious about being around other people and cause social anxiety. For example, research shows people with RCPD take steps like:

• Fasting (not eating) before important events, like job interviews, meetings or celebrations, to reduce the risk of RCPD symptoms
• Scheduling time to relieve gas in order to avoid offending other people around them

Why RCPD happens

While the exact cause of RCPD is unknown, doctors think it’s a problem with how the body works, not with its structure. Experts know RCPD happens when your cricopharyngeal muscle (upper esophageal sphincter) doesn’t relax as it should. But they aren’t sure why this happens.

Your cricopharyngeal muscle is at the top of your esophagus. It opens and closes to let food and liquid into your esophagus and farther down to your stomach. It also opens to vent air out of your stomach when there is too much air.

“Normally, that air would flow through your esophagus and out your nose and mouth,” explains Dr. Schneider. “When you have RCPD, though, your cricopharyngeal muscle doesn’t open. Instead, air gets stuck in your esophagus and stomach.”

How to manage RCPD

If you think you have RCPD, Dr. Schneider suggests talking to a healthcare provider. During your appointment, they’ll review your medical history and perform a physical exam. You may need a diagnostic test like an upper endoscopy or X-ray. Your doctor may also request additional tests to rule out other conditions that cause similar symptoms.

If your provider suspects RCPD, the recommended treatment is to inject Botox® into your cricopharyngeal muscle. These injections relax the cricopharyngeal muscle and allow you to burp and relieve your symptoms. This is usually done under general anesthesia.

“The paralyzing action of the botulinum toxin injections may last approximately three months, but it can be even longer,” notes Dr. Schneider.

In some cases, Botox injections may make it hard for you to swallow (dysphagia). But this side effect wears off within one to four weeks.

Alternative treatments may include a balloon catheter dilation, which is used to widen your esophagus. Your healthcare provider may also recommend working with a speech-language pathologist who specializes in swallowing disorders.

Talk to your healthcare provider if your RCPD symptoms come back after treatment.

Bottom line?

For most people, burping comes easily. In fact, many of us may apologize when a burp erupts when we’re around others. But if you’re having trouble burping and think you may have RCPD, talk to a healthcare provider.