Can't Burp? Retrograde Cricopharyngeal Dysfunction And Botox Treatment

In this Science Quickly episode, host Kendra Pierre Lewis explains retrograde cricopharyngeal dysfunction, a condition in which some people cannot burp or vomit, leading to uncomfortable bloating and chest pressure. An otolaryngologist, Dr. Robert Bastian, discusses how the upper esophageal sphincter normally relaxes to vent swallowed air, how RCPD disrupts that process, and the constellation of diagnostic symptoms doctors rely on. The segment then details a Botox-based treatment delivered through two approaches that temporarily relax the sphincter, enabling burps and sometimes vomiting, with noticeable relief for many patients. The conversation highlights how patients describe the change as life altering and emphasizes that therapy also serves as a form of training for the muscles involved in belching.

Overview

In this episode of Scientific American Science Quickly, host Kendra Pierre Lewis introduces retrograde cricopharyngeal dysfunction, a rare condition where the upper esophageal sphincter remains contracted, preventing belching or vomiting, while swallowing remains largely normal. The discussion covers how swallowed air forms a gastric bubble, why the inability to vent it leads to bloating and chest discomfort, and how clinicians build a diagnosis from a constellation of symptoms rather than a single test.

Origins and Diagnosis

Dr. Robert Bastian, an otolaryngologist, explains how the syndrome was codified in 2019 and why standard manometry often misses it. He notes that about one third of patients report a lifelong inability to burp, while others develop symptoms later in life. The diagnostic picture includes inability to burp, gurgling noises, bloating, flatulence, hiccups, hypersalivation, shortness of breath, nausea after eating, eetophobia, and constipation, with the primary complaint of no burping guiding the assessment. "Your diagnostic accuracy is practically 100%" - Dr. Robert Bastian

Treatment with Botox

Treatment centers on relaxing the upper esophageal sphincter with Botox, delivered under general anesthesia by two main methods: a transoral injection into the sphincter muscle or an EMG-guided approach with electrodes and a needle. Botox causes temporary chemical denervation, allowing the sphincter to relax so burps, and sometimes vomiting, can occur during the effectiveness window, typically lasting a few months. The physician emphasizes the procedure as straightforward and highly impactful for daily life. "Botox lasts 3 to 5 months" - Dr. Robert Bastian

Learning to Burp and Recovery

During the Botox window, patients learn to recognize the sensations that precede a burp and develop a gesture or fidget to release the gas. The doctor describes the approach as training wheels for the muscle, with gradual improvements as the Botox effect fades and patients continue to burp on their own. "It's a training wheels kind of idea" - Dr. Robert Bastian

Clinical History and Patient Impact

The episode traces the journey from the index patient in 2015 to a growing caseload, illustrating how effective treatment can transform life for people who previously endured severe daily misery. Some patients describe the relief as life changing, with improved meals and social experiences, while others report lifelong patterns of non burping dating back to infancy. "Index patient for me was in 2015" - Dr. Robert Bastian

Conclusion

The discussion closes by underscoring Botox as a simple, effective option to improve quality of life and reduce distress, with the potential for lasting benefits as patients learn to belch during the therapy window.