Retrograde Cricopharyngeal Dysfunction

R-CPD – Inability to burp!

Many people suffer of an inability to burp. They are noburpers.

Many people have a strange suffering: they cannot burp. These people often think that they are the only ones. They don’t know that they have many fellow sufferers. It’s  a 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.“
R-CPD Inability to burp

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 of the inability to burp

There is no finally known cause for this symptoms.
Burping is a dysfunction caused by the cricopharyngeal muscle. The cricopharyngeal muscle is a muscle band that forms the upper entrance to the esophagus (esophageal sphincter). This is a valve-like area in the throat. The cricopharyngeus muscle narrows the pars laryngea of ​​the pharynx and thereby pushes food towards the esophagus during the swallowing act.
The function of the cricopharyngeal muscle is to prevent gastric contents from flowing back into the throat. If this muscle changes into a constant spasm, simple belching is prevented.

The cricopharyngeal sphincter is usually in a state of contraction and relaxes only to allow food to pass down or during belching (and vomiting). People who are unable to burp, the Cricopharyngeus muscle cannot relax, which is why gas is often trapped in the esophagus. Patients suffering from this disorder often complain of the above. Discomfort and sometimes gurgling, deep behind the chest wall. They often avoid carbonated drinks as this can make their symptoms significantly worse

Therapy with 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.


For treatment we will injecting  BTX into the Cricopharyngeus muscle. This leads to a temporary, partial paralysis of this muscle and therefore enables burping. The injections are usually carried out on an outpatient basis (i.e. without an overnight stay in a hospital). Most patients learn burping after about 3 – 30 days. Some patients may need to repeat the injection.


Some patients may experience excessive regurgitation and difficulty swallowing, but this usually improves as soon as the injection wears off. Vocal disorders can occur as an undesirable side effect if the vocal cord nerves have been affected as well as breathing difficulties. However, these symptoms should disappear in a few weeks. Serious complications are rare.
All in all, it is a very helpful and effective therapy, which can help those affected to have a significantly improved quality of life.

R-CPD – Effects on everyday life. Description from the perspective of a person concerned

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.

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.


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.

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.