I recently discovered that some individuals have an unfortunate affliction, leaving them physically incapable of burping. While you may be thinking, that's clearly not the worst fate someone could suffer, well, you'd probably be right...BUT can you imagine the pain and discomfort caused by constant bloating with nowhere to go?? This condition is known as Retrograde cricopharyngeal dysfunction (RCPD), and it has only recently gained attention among physicians and patients alike. To simplify things, it’s a dysfunction of the upper esophageal sphincter (UES) leading to a variety of symptoms (Miller et al., 2024).
- Inability to burp
- Abdominal fullness and bloating
- Gurgling noises in the chest or lower neck
- Excessive flatulence (the only other exit...)
Normally, the UES will relax during the early phase of swallowing in order to prevent regurgitation and limit the air entering the stomach when we breathe (Miller et al., 2024). This sphincter is partially under voluntary control, allowing us to intentionally relax the muscle when we burp.
As we know, there are actually two sphincters within the esophagus. The upper located at the junction of the pharynx and the esophagus, and the lower where the esophagus meets the stomach. When you burp, the lower esophageal sphincter relaxes (LES) and gas from the stomach moves upward (Miller et al., 2024). This rising gas then distends the esophagus, which would prompt most people to relax their UES and release that gas, at the risk of their social etiquette status, of course.
While the pathophysiology isn't fully understood, in RCPD patients it is believed that the LES relaxes normally, but the UES fails to relax properly (Miller et al., 2024). This traps the air in the esophagus, building up an uncomfortable amount of pressure until peristalsis eventually “swallows” the air and pushes it back into the stomach. This back and forth movement of gas is what produces the gurgling sound many patients describe (Miller et al., 2024).
Luckily, there is a solution! Physicians found that a botulinum toxin A injection into the cricopharyngeal muscle is a successful treatment. I won't go into the details on this mechanism as I’m pretty sure y'all are familiar. After the injection, most patients experience rapid symptom relief and the restoration of the ability to belch (Larsen et al., 2025). While some patients may need repeated doses, many reports suggest that the effect of this toxin may extend beyond its typical pharmacological duration, potentially due to the reconditioning of the belch reflex (Larsen et al., 2025).
With RCPD being a relatively new addition to medical literature, many patients with mild symptoms may be unaware that this condition is the source of their discomfort. In fact, a surprising number of people only discover RCPD after stumbling across someone describing the exact same symptoms on some form of social media. On the other hand, patients who previously sought medical care and were given diagnoses like irritable bowel syndrome (IBS) or were unsuccessfully treated with anti-reflux medications now have both a cause and a cure.
I thought this was an interesting addition to the long list of diverse applications our old friend botox can serve in. Learning about this condition has allowed me to appreciate my functional esophagus a bit more when I enjoy the occasional carbonated beverage. So if you’ve never been able to burp, maybe this helped you put a name to it. I’ve never really thought about it before, but if I had to pick a side, I’d have to be pro-burp. It’s a normal bodily function after all. I’ll conclude with the words of Shrek as they apply perfectly to this discussion, “Better out than in.”
References:
Larsen DG, Aalling M, Udholm N, O'Leary P. Retrograde cricopharyngeal dysfunction management with botulinum toxin A. Dan Med J. 2025 Jul 22;72(8):A03250166. doi: 10.61409/A03250166. PMID: 40747725. https://pubmed.ncbi.nlm.nih.gov/40747725/
Miller ME, Lina I, Akst LM. Retrograde Cricopharyngeal Dysfunction: A Review. J Clin Med. 2024 Jan 11;13(2):413. doi: 10.3390/jcm13020413. PMID: 38256547; PMCID: PMC10817096. https://pubmed.ncbi.nlm.nih.gov/38256547/
So Botox is the cure for everything it would seem. I guess if Shrek ever got Botox it would be to improve his belching. It does make you wonder what other physical abnormalities people have without ever realizing it. It's amazing to me how frequently things are misdiagnosed. I think there needs to be a greater emphasis on advocating for your own health in our society. Doctors are a bit too revered and their opinions are seen as far too irrefutable in my opinion.
ReplyDeleteSuper interesting, Maggie! It's funny you mention hearing about this on social media because that's exactly where I've heard of this too. I had no idea that botox was a fix though! It seems like a great way to encourage the body to allow burping. However, I'm curious if people who have received botox for this are at more risk of choking or aspiration? If the UES is always relaxed, the esophagus may always be expecting food and cause the epiglottis or sphincter itself to not close off that pathway when eating.
ReplyDeleteWhat an interesting post Maggie. Considering you were the first women I have ever heard burp in real life. How often would people need to get a botox injection to be able to burp? And to piggy-back off of Shannon, would this affect people eating regularly or maybe even when they vomit? Why would someone want to burp, is there any downside to not having this problem fixed?
ReplyDeleteI cannot believe you have never heard a woman burp, as if we’re some alien species incapable of such an atrocity. I’m glad I could give you that experience, I'm all for challenging stereotypes... although that was supposed to stay between you and me, haha! Anyway, to answer your question, all of the patients in the study I referenced received an initial injection of 50 IU of botulinum toxin A. If that didn’t do the trick, they were offered higher doses of 75 or 100 IU. Some patients even required a third or fourth injection if the previous ones were unsuccessful. The toxin typically lasts for about 3 months so patients usually had a long term follow up at that point. However, because RCPD is so newly recognized there isn’t a fixed protocol for follow-up care, it seems to be more of a case by case basis depending on when a patient’s symptoms return.
DeleteWhen it comes to eating/swallowing RCPD patients are unique in that these functions are not usually disrupted. In fact, difficulty vomiting is actually another common symptom seen before treatment. With that said no complications with eating were reported after botox injection, and one can infer that patients can also more comfortably “spill their guts,” if you will. While it may not seem important, being unable to belch can really hinder many someone’s quality of life, causing uncomfortable symptoms every single day. I mean, look at Shrek, he’s a happy lad as long as no one’s messing around in his swamp!
I found this post very much so oddly interesting, Maggie. Thank you for sharing. As you mentioned before, I am quite astounded by the versatility of botox injections. For someone who really did not understand the full scope of the injection outside of cosmetic purposes prior to the program, I am impressed by what botox injections can do for the physiology in our bodies. It makes me also wonder, what may be some of the ramifications for people who burp far too often? I am sure that is a condition, as well. I am curious of the medical procedures that renders from the over expulsion of gas from the body. While those who may not be able to burp often enough be subject to aspirations in the lung, people who burp too often are subject to aerophagia where this the swallowing of too much air (Bredenoord, 2013). It is due to all the gas buildup for the releasing as burp.
ReplyDeleteBredenoord, A. J. (2013). Management of belching, hiccups, and aerophagia. Clinical Gastroenterology and Hepatology, 11(1), 6–12. https://doi.org/10.1016/j.cgh.2012.09.006