R-CPD (retrograde cricopharyngeal dysfunction): when you cannot burp
Some people are unable to burp. Instead, they experience gurgling sounds in the throat, bloating and pressure in the chest after meals. The cause may be R-CPD – a condition in which the muscle at the top of the oesophagus does not relax when air needs to escape upwards. At Charlottenlund Private Hospital, R-CPD is assessed and treated by a specialist in ear, nose and throat diseases.
What symptoms does R-CPD cause?
The main symptom is an inability to burp. Other symptoms include gurgling or creaking sounds from the throat and chest, particularly after eating and drinking, bloating, pressure or discomfort in the chest and abdomen and increased flatulence because the air has to pass through the digestive system instead. Some people also have difficulty vomiting, and carbonated drinks often cause discomfort.
According to a Danish study published in Ugeskrift for Læger, symptoms typically appear during adolescence or early adulthood. The condition is not dangerous, but the noises and bloating can have a considerable impact during meals and in social situations.
Why are people with R-CPD unable to burp?
A normal burp begins when air from the stomach rises and expands the oesophagus. In response, the upper oesophageal sphincter briefly relaxes, allowing the air to escape through the throat.
In R-CPD, this relaxation does not occur: the cricopharyngeus muscle remains tense when air approaches from below, and the air stays trapped in the oesophagus. When swallowing, the muscle functions normally. The problem only affects passage in the opposite direction – hence the term retrograde, meaning backwards.
According to the Danish study, it is not yet fully understood why this reflex is absent in some people.
Can R-CPD be confused with other conditions?
Yes. Bloating and excess gas are often the most noticeable symptoms, which means that many people are initially assessed for other conditions. In the Danish study, several patients had previously been diagnosed with irritable bowel syndrome, while others had been treated with acid-suppressing medication without effect.
What distinguishes R-CPD is the combination of an inability to burp and gurgling sounds from the throat and chest. Part of the diagnostic process therefore involves ruling out other possible causes so that the correct diagnosis can be made.
How is R-CPD diagnosed?
The diagnosis is primarily based on the medical history because the pattern of symptoms is highly recognisable.
According to Ugeskrift for Læger, the assessment includes a thorough ear, nose and throat examination with an endoscopic examination of the pharynx and larynx (flexible laryngoscopy), which most often shows no abnormal findings.
The main purpose of the examination is to rule out other possible explanations for the symptoms. There is no blood test that can detect R-CPD. If the specialist considers additional examinations of the oesophagus necessary, a referral will be arranged.
How is R-CPD treated?
R-CPD is treated with an injection of botulinum toxin into the cricopharyngeus muscle. The substance causes the muscle to relax for a period of time, allowing air to escape again and potentially restoring the ability to burp.
The procedure is performed as an outpatient procedure under general anaesthesia and is carried out through the mouth. Afterwards, temporary symptoms such as mild difficulty swallowing, throat soreness or acid reflux may occur while the effect is strongest.
The treatment has been described in both Danish and international studies.
How effective is the treatment?
In a Danish study published in Ugeskrift for Læger in 2025 involving 40 patients aged between 19 and 53, more than half achieved a satisfactory result after the first injection, while approximately one third received a second treatment.
Side effects were mild and temporary, and no patients experienced problems with their voice or breathing. The effect of botulinum toxin gradually wears off, but many people retain the ability to burp afterwards. One possible explanation is that the reflex is learned while the muscle is relaxed.
Results vary from person to person and cannot be predicted in advance.
When should you see a doctor?
It may be appropriate to see an ear, nose and throat specialist if you are never or rarely able to burp and also experience gurgling sounds, bloating, pressure in the chest or increased flatulence – particularly if the symptoms affect meals, work or social situations.
Many people have experienced these symptoms for years without knowing that the condition has a name. Difficulty swallowing, pain or unintentional weight loss should always be assessed by a doctor, as these symptoms may have other causes that need to be ruled out first.
Treatment has three steps: initial consultation, treatment and follow-up. During the initial consultation, the specialist reviews your symptoms, examines your throat and larynx with an endoscope and assesses whether botulinum toxin treatment is appropriate. The procedure itself is performed under general anaesthesia in the operating department in Charlottenlund, and you go home the same day. Afterwards, the effects are reviewed, either by phone or in person, depending on what you agree with the specialist.
Referral and payment
Most patients at Charlottenlund Privathospital are covered by a health insurance policy; insurers typically require a referral from your GP and pre-approval. No referral is needed if you are paying for treatment yourself, and prices are listed in the price list. If the waiting time in the public healthcare system is over 30 days, you may be entitled to region-funded treatment through the extended free hospital choice scheme.
Who treats R-CPD at Charlottenlund Privathospital?
R-CPD care is provided by Michael Howitz, a specialist in ear, nose and throat medicine. He is responsible for the initial consultation, treatment and follow-up.
Frequently Asked Questions
What is R-CPD?
R-CPD (retrograde cricopharyngeal dysfunction) is a condition in which you cannot burp because the upper esophageal sphincter does not relax to let air travel upward.
Why can’t I burp?
In otherwise healthy people, the most common explanation is R-CPD, where the cricopharyngeus muscle remains tense as air rises from the stomach. An ear, nose and throat specialist can determine whether this is the cause in your case.
Is it dangerous not to be able to burp?
No, R-CPD is not a dangerous condition—but the symptoms can significantly affect quality of life, and they can be treated.
How is R-CPD treated?
With an injection of botulinum toxin (Botox) into the cricopharyngeus muscle, which relaxes the muscle and allows air to escape.
Is the treatment painful?
The treatment is performed under general anaesthesia, so you will not feel the procedure itself. You may have temporary soreness in your throat afterwards.
How long does the treatment last?
The effect of botulinum toxin wears off over a few months, but many people retain the ability to burp afterwards. Some people need another treatment.
What are the side effects?
According to the Danish study, side effects are mild and temporary—typically mild difficulty swallowing and a sore throat in the period after treatment.
Do I need a referral?
No, as a rule you do not—you can book an appointment directly. However, some health insurance policies require a referral or pre-approval.
What does the process involve?
First, an initial consultation with an ear, nose and throat specialist, followed by treatment under general anaesthesia, and finally a follow-up, which can often be conducted by phone.