Retrograde Cricopharyngeus Dysfunction (R-CPD)
Many people suffer of an inability to burp (R-CPD). They are noburpers.
Many people have a strange condition: They cannot burp. Often these people think that it is only them and do not know that they have many fellow sufferers. They have Retrograde Cricopharyngeal Dysfunction, or R-CPD for short.
“For those who can’t burp. It’s real, and it sucks.”
„I am 30 years old and I have never been able to burp. When I try to burp, I just get an artificial cough, or you almost throw up. I think the worst symptom for me was gurgling in the throat.“
„Carbonated drinks are hell. The air doesn’t make me feel sick immediately, but I have severe chest pain. I have this pain every day so I can’t do much. Sometimes I hit my chest hard and try to force the air out.“
„Like many others, I can never belch. I have big problems with bloating, flatulence and frills. The only relief I could find, the vomiting the air. I constantly had to choke to relieve the bloating and gurgling.”
Most patients are between 20 and 30 years old but any age can be affected. Many patients have had the problems since childhood but it has never been diagnosed.
Possible causes for the inability to burp / Retrograde Cricopharyngeus Dysfunction (R-CPD)
There is no definitive known cause for this complaint. The function of the cricopharyngeal muscle is to prevent reflux of gastric contents into the pharynx. If this muscle goes into constant spasm, simple regurgitation is prevented.
Not being able to burp is a dysfunction caused by the cricopharyngeal muscle. The cricopharyngeal muscle is a band of muscle that forms the upper esophageal sphincter. This is a valve-like area in the throat. The cricopharyngeus muscle constricts the pars laryngea of the pharynx, thus pushing food toward the esophagus during the act of swallowing.
The sphincter is the culprit
Not being able to burp is a dysfunction caused by the cricopharyngeal muscle. The cricopharyngeal muscle is a band of muscle that forms the upper esophageal sphincter. This is a valve-like area in the throat. The cricopharyngeus muscle constricts the pars laryngeal of the pharynx, thus pushing food toward the esophagus during the act of swallowing.
The cricopharyngeal sphincter is normally in a state of contraction and relaxes only to allow the passage of food downward or upward during burping (and vomiting). In people who are unable to burp, the cricopharyngeus muscle cannot relax, so gas often becomes trapped in the esophagus. Patients suffering from this disorder often complain of the above symptoms and sometimes of gurgling, deep behind the chest wall. They often avoid carbonated beverages, as this can significantly worsen their symptoms. Likewise, many patients complain of air in the abdomen (bloated abdomen). The abdomen inflates uncomfortably and causes pain.
Hope: Targeted injections
Dr. Robert W. Bastian from the Bastian Voice Institute, Chicago, identified the cricopharyngeus muscle as a possible source of suffering. Dr. Bastian also wrote the first publication on retrograde cricopharyngeal dysfunction (R-CPD) “Inability to Belch”. His therapeutic approach is a targeted injection of a nerve poison into the pharynx. Obviously it was the right approach, because the patients could regurgitate after a few days.
Prof. Markus Hess learned from Dr. Bastian in Chicago the correct setting of injections and uses this method successfully with his patients with R-CPD.
Treatment: Injection Therapy
R-CPD is treated by injecting BTX into the cricopharyngeus muscle. This leads to temporary, partial paralysis of this muscle and therefore enables belching. The injections are usually performed under short anesthesia on an outpatient basis (i.e., without an overnight hospital stay). Most patients subsequently learn to burp after about 3-30 days. Some patients may require a repeat injection.
Some patients may temporarily experience excessive belching and difficulty swallowing, but this usually improves as soon as the effect of the injection wears off. Vocal disturbances may occur as an adverse side effect if the vocal cord nerves have been affected, as may breathing difficulties. However, these symptoms should improve in a few weeks or months. Serious complications are rare. Overall, therefore, it can be assumed that this is a very helpful and effective therapy that can help sufferers to achieve a significantly improved quality of life.
R-CPD – Effects on everyday life.
No chance to burp
No possibility of burping consciously or unconsciously and letting air escape from the stomach upwards.
Bloated, painful feeling of fullness after meals. The air builds up in the stomach. Always the feeling that the air wants to ascend the esophagus, but meets a blockage.
Bloating of the abdomen
As the day progresses, the stomach becomes bloated (even without meals).
Abdominal pain when traveling by plane from 1.5 hours due to long sitting and the developing air bubble in the abdomen.
Frog-like air noises
The fact that the air does not come out creates uncontrollable dull, gurgling, frog or toad-like noises. This is particularly unpleasant for the environment.
Embarrassing moments because of excessive flatulence
Excessive, severe flatulence, on the one hand, after large meals and, on the other hand, when meals are completely absent.