What Is No-Burp Syndrome?

Some people realize that they are never able to burp. After meals, when drinking fizzy beverages, or when their stomach feels bloated, they try to burp for relief, but it is simply not possible. This condition is called No-Burp Syndrome, or by its medical name, Retrograde Cricopharyngeal Dysfunction (R-CPD).

This problem occurs because a muscle in the throat, located at the entrance of the esophagus (the cricopharyngeus muscle), does not open during gas release. In other words, the issue is not with the digestive system itself, but with the inability of this muscle to relax at the right time.

What Are the Symptoms?

The most common symptoms include:

• Complete inability to burp

• Excessive bloating and abdominal pressure after eating or drinking

• A sensation of trapped gas in the throat

• Gurgling or “wet-sounding” voice

• Discomfort in social situations due to noises from the stomach or throat

• Reflux-like complaints

What Causes It?

The exact cause is not known. Usually, there is no structural problem visible on imaging. Instead, it is a functional disorder in the way the muscle works. The muscle itself is healthy but does not function properly.

How Is It Diagnosed?

Diagnosis is mainly based on the patient’s symptoms. If you are unable to burp and experience the symptoms above, you may have this condition.

In some patients, additional tests may support the diagnosis, such as:

• Endoscopy (visualizing the throat and esophagus)

• Swallowing studies (especially videofluoroscopy)

• Manometry (a special test that measures pressures in the esophagus)

Is There a Treatment?

Yes, there is an effective and relatively simple treatment. The most commonly used and successful method is: Botox Injection

• Botulinum toxin (Botox) is injected into the cricopharyngeus muscle.

• This temporarily relaxes the muscle.

• The injection is done either through the neck under local anesthesia with EMG guidance, or through the mouth with light anesthesia using endoscopy.

• The effect begins within a few days, and the burping reflex reappears.

• For some patients, a single injection is enough, while others may need a repeat injection after a few months.

What Happens After Botox?

• Within the first few days, you begin to burp.

• At first, gas may be released frequently, but this balances out over time.

• Rarely, short-term swallowing difficulty may occur, which is usually temporary.

• Sometimes, there may be mild and temporary hoarseness or vocal weakness.

• Most patients experience significant relief after Botox.

In Summary

Although rarely seen, No-Burp Syndrome can greatly affect quality of life. However, with the right diagnosis and appropriate treatment, it can be largely resolved.