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Burping is one of those things that is so normal that people just assume everyone can do it. But that’s not actually true: There are, in fact, people who simply can’t burp.
Though no-burpers aren’t exactly legion, awareness of the condition is growing. In 2019, doctors came up with a name for it: retrograde cricopharyngeal dysfunction, aka R-CPD.
While the causes behind the condition are not fully understood, the treatment is relatively straightforward. Here’s what you need to know about not being able to burp.
Why can’t I burp?
To understand R-CPD (colloquially termed “no-burp syndrome” or “abelchia” for obvious reasons), a quick anatomy lesson is in order.
Your esophagus is a long tube that connects your throat (aka your pharynx) to your stomach. When you swallow food or liquid, it passes through your esophagus into your stomach.
At the top of your esophagus is a muscle called the cricopharyngeus, which makes up part of your upper esophageal sphincter. When you swallow, the cricopharyngeous relaxes, allowing the upper esophageal sphincter to open. Food can then easily pass from the pharynx into the esophagus. After that happens, the cricopharyngeus contracts and closes the upper esophageal sphincter so the food you just ate doesn’t come back up.
“The cricopharyngeus also prevents us from swallowing too much air,” says John Paul Giliberto, MD, an otolaryngologist at the Otolaryngology-Head and Neck Surgery Center at UW Medical Center – Montlake.
At rest, the muscle is contracted, which keeps the esophageal sphincter closed. But for most people, the muscle relaxes to allow air to escape when you burp (and other stuff to escape when you throw up). For people with R-CPD, however, the cricopharyngeus is a little too determined to stay contracted and doesn’t recognize that it needs to relax to let air back out as a burp. Air then gets trapped in your stomach, causing some occasionally awkward — and sometimes debilitating — symptoms.
No one really knows why the cricopharyngeus starts behaving this way or how common the condition is. Judging by data collected about R-CPD patients in the last few years, the disorder is something people are born with.
“It is much more common for me to work with people who have problems with too much burping (eructation) than the inability to burp, but neither disorder is common,” says Alison Hirst, MS, a speech-language pathologist who sees patients in the Otolaryngology-Head and Neck Surgery Center at UW Medical Center – Montlake.
What are the symptoms of no-burp syndrome?
First off, one thing to note: “If your symptoms don’t bother you, you don’t have to do anything about it,” Giliberto says.
Symptom severity among no-burpers varies widely, but some people experience so much pain after eating, that they need treatment in order to function.
The most common symptom of R-CPD is, of course, not being able to burp, especially when you feel like you need to burp. Other symptoms include:
- Pain, pressure or discomfort in the abdomen, chest, or throat, especially during or after eating
- Nausea
- Gurgling noises in the stomach, chest or throat, which can cause embarrassment or shame, especially when eating in public
- Abdominal bloating
- Excessive gas
- In some people, an inability to throw up
“It is truly uncomfortable for patients to experience these symptoms, and it can be frustrating to seek care as most exams are going to come back with normal results, which is not affirming to the person with the symptoms,” Hirst says. “I always think that patients should advocate for their care and that they should know there is help for this disorder.”
Interestingly, no-burpers seem to be more likely to have an anxiety disorder and a fear of vomiting, aka emetophobia, but this is based on anecdotal reports rather than scientific evidence.
How is R-CPD diagnosed?
The first part of diagnosing no-burp syndrome is ruling out other conditions, including other swallowing disorders.
Since R-CPD is not well-recognized, even among doctors, it may be misdiagnosed as acid reflux or irritable bowel syndrome. Aerophagia, or excessive air swallowing, and even gallbladder issues can masquerade as R-CPD. Sometimes, though, it’s the other way around: It’s common for people with gastroesophageal reflux disease (GERD) to experience some of the same symptoms, Giliberto says.
Your primary care doctor might initially refer you to a speech-language pathologist, like Hirst, who will ask about your symptoms and observe how you swallow. Additionally, you will likely need to undergo a modified barium swallow study, which is a type of X-ray video that records the entire swallowing process so doctors can see how your particular throat and esophagus function.
A diagnosis is then usually made based on the swallow study findings and the symptoms someone is experiencing.
Is there treatment for not burping?
The main treatment for R-CPD is actually relatively simple: Inject the cricopharyngeus with botulinum toxin, aka Botox.
Since around 90% of patients with R-CPD will notice their symptoms improve significantly after a Botox injection, Giliberto will also use the treatment to confirm that they do, in fact, have R-CPD.
The injection works by temporarily weakening the cricopharyngeus, causing it to relax and allowing burps to make their way out.
“With R-CPD, the benefit will last well beyond how long the Botox works, which is three to four months,” Giliberto says. “About 70% of patients have benefits six to 12 months after the intervention.”
The thought is that, in many people, the injection re-trains the muscle how to work properly, so no additional injections are needed.
There are relatively few side effects to the procedure, though you may have to go under anesthesia for it. If you’re interested in this treatment, Giliberto recommends asking your doctor for a referral to a laryngologist. If you want to discuss other treatment options, you could instead ask for a referral to a speech-language pathologist.
Five things that will help you manage not burping
If not being able to burp is causing you discomfort, but you want to try something else before Botox, Hirst recommends a few simple practices that reduce how much air you’re swallowing.
Pay attention to swallowing
It’s normal to swallow two or three times per minute. More times than that might introduce excess air into your esophagus and stomach. When not using your tongue to swallow, try to keep it in a relaxed position (aka not shoved against the roof of your mouth).
Also, you know when you’re swallowing and your tongue moves back and up inside your mouth? This is called tongue pumping, and doing it too much can increase the amount of air you’re swallowing.
Take deep breaths
Diaphragmatic breathing, also known as stomach breathing, brings in air at a slower pace, helping you feel like you’re getting full breaths. This kind of deep breathing can also help you relax. It helps prevent excess air intake that can contribute to R-CPD symptoms.
Try the Mendelsohn maneuver
This involves helping your esophagus stay open and giving air a chance to escape in a burp. First, identify your larynx, aka your voice box or Adam’s apple, which is the tube at the top of your throat that allows you to make sounds and speech. As you start to swallow, use your throat muscles to hold your larynx at its highest point. (You may need to touch it on the outside of your throat so you know where it’s located and how it feels to hold it.) Then, finish the swallow normally. Note: Don’t do this while drinking or eating.
Maintain good posture
If you’re shrimping out all day over your computer, with your back hunched, shoulders up and jaw clenched, this might put pressure on your chest and make you breathe more shallowly and quickly.
Give your esophagus some extra help
Eating more slowly, taking smaller bites, eating smaller meals, avoiding foods that trigger reflux and taking a leisure walk after eating can all help your esophagus (and cricopharyngeus) do its job. It’s also important not to eat or drink while lying down, do strenuous exercise after eating or bend over or lift a heavy object right after eating.
So even though R-CPD can be uncomfortable, there are things you can do to ease your symptoms — and you shouldn’t feel like you’re the only person in the world who can’t burp.
