R-CPD (Retrograde Cricopharyngeal Dysfunction): The inability to burp

R-CPD (retrograde cricopharyngeal dysfunction) is a condition in which a person is unable to burp because the upper oesophageal sphincter (the cricopharyngeus muscle) does not relax when air needs to travel upwards. Air becomes trapped in the oesophagus and stomach, causing gurgling sounds, bloating and increased flatulence. The condition was first described by Bastian and Smithson in 2019, and according to Ugeskrift for Læger, the first Danish patient was treated in 2021. R-CPD is treated with an injection of botulinum toxin into the muscle.



What symptoms does R-CPD cause?

The main symptom is an inability to burp – often, the person has never been able to burp, even as a child. In addition, most people experience gurgling or creaking sounds from the throat and chest, particularly after eating and drinking, as well as bloating, pressure in the chest and increased flatulence because the air has to pass through the intestinal system instead.

Some people also experience painful hiccups and discomfort when drinking carbonated beverages. Symptoms typically become more noticeable in social situations and can significantly affect quality of life, even though the condition itself is harmless.

Why are you unable to burp with R-CPD?

A normal burp occurs when air from the stomach rises into the oesophagus, causing it to expand. In response, the upper oesophageal sphincter relaxes, allowing the air to escape through the throat.

With R-CPD, this relaxation does not occur. The cricopharyngeus muscle remains contracted when air approaches from below, causing the air to become trapped in the oesophagus. The muscle functions normally during swallowing – the problem only occurs when air needs to travel in the opposite direction, hence the name retrograde cricopharyngeal dysfunction.

Can R-CPD be mistaken for other conditions?

Yes – many people with R-CPD have been told for years that their symptoms were caused by something else, such as excess stomach acid, reflux or irritable bowel syndrome, because bloating and intestinal gas are often the most prominent symptoms.

The characteristic feature that distinguishes R-CPD is the inability to burp combined with gurgling sounds in the throat and chest. For this reason, part of the assessment involves ruling out other possible causes so that you receive the correct diagnosis and treatment.

How is R-CPD diagnosed?

The diagnosis is primarily based on your medical history – the typical combination of an inability to burp, gurgling sounds and bloating is often highly recognisable.

According to Ugeskrift for Læger, the assessment includes a thorough ear, nose and throat examination, including an endoscopic examination of the throat and larynx (flexible laryngoscopy), which most often shows no abnormalities. The main purpose of the examination is to rule out other causes of the symptoms. There is no blood test or scan that can independently diagnose R-CPD.

How is R-CPD treated?

R-CPD is treated with an injection of botulinum toxin (Botox) into the cricopharyngeus muscle. The botulinum toxin temporarily relaxes the muscle, allowing air to escape again – and restoring the ability to burp.

The treatment is performed through the mouth under general anaesthesia and takes only a short time. After treatment, some people may temporarily experience mild symptoms such as slight difficulty swallowing or soreness in the throat while the botulinum toxin is having its strongest effect. The treatment is well documented in both Danish and international studies.

How effective is the treatment?

In a Danish study published in Ugeskrift for Læger, more than half of the patients achieved a satisfactory result after the first injection, while around one-third received another treatment with a higher dose.

Side effects were mild and temporary – typically slight difficulty swallowing and throat soreness – and no serious complications were observed. The effect of botulinum toxin gradually wears off over several months, but many people retain the ability to burp afterwards. Some patients require another treatment.

When should you see a doctor?

You should consider consulting 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 your everyday life, meals or social situations.

Many people with R-CPD have lived with the symptoms for years without knowing that the condition has a name and can be treated. If you experience difficulty swallowing, pain or weight loss, you should always be examined, as these symptoms may have other causes that need to be ruled out first.

Treatment at Charlottenlund Privathospital

At Charlottenlund Privathospital, we have been treating R-CPD for many years, and the condition is one of our particular areas of experience within ear, nose and throat surgery.

The treatment process begins with an initial consultation with an ENT specialist, who will review your symptoms, examine your throat and larynx and assess whether treatment with botulinum toxin is the right option for you. The treatment itself is performed under general anaesthesia, followed by a follow-up consultation – often by telephone – to assess the effect.

As a general rule, you do not need a referral, and the price of the initial consultation and treatment can be found in our price list. You can book an appointment online or contact us if you have any questions beforehand.

Sources:

Retrograde cricopharyngeal dysfunction. Ugeskrift for Læger (review article). ugeskriftet.dk

Retrograde cricopharyngeal dysfunction management with botulinum toxin A. Danish Medical Journal / Ugeskrift for Læger (2025). ugeskriftet.dk

Bastian RW, Smithson ML. Inability to belch and associated symptoms due to retrograde cricopharyngeus dysfunction: diagnosis and treatment (2019).