R-CPD – The inability to burp

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.“
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 (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 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.


R-CPD is treated by injecting BTX into the cricopharyngeus muscle. This leads to a temporary, partial paralysis of this muscle and therefore enables belching. The injections are usually performed under a 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. 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.