Retrograde cricopharyngeus dysfunction (RCPD)

What is retrograde cricopharyngeus dysfunction?

Retrograde cricopharyngeus dysfunction (RCPD), also known as no-burp syndrome, is a rare digestive condition that affects the top of the oesophagus (the tube connecting the mouth and stomach that food travels through). People with RCPD are physically unable to burp, belch or, in some cases, even vomit.

Generally, burping is a natural function your body does to get rid of excess air in your stomach. Those with RCPD can’t relax muscles in the oesophagus to allow this excess air to escape.

If you are living with RCPD or think you may be and would like a diagnosis, our specialists can help you find the treatment you need.

Common symptoms of retrograde cricopharyngeus dysfunction

The main symptom of RCPD is being unable to burp or never having been able to burp.

Other symptoms you may experience with the condition include:

• Loud digestive noises, e.g. gurgling
• Excess flatulence (farting)
• A feeling of fullness
• Abdominal swelling or bloating
• Nausea
• Painful hiccups
• Pain in the throat or chest
• Abdominal pain or discomfort
• Back pain

What causes retrograde cricopharyngeus dysfunction?

The exact cause of RCPD is not known, as further research is needed to find and confirm how it starts.

Experts suspect it may be a problem with how the body works, not with its structure (e.g. with how the oesophagus is formed).

RCPD seems to mostly affect young adults, often with symptoms beginning in childhood or adolescence. It seems to be slightly more common in male patients, but because it is a rare condition, we can’t determine whether this is definitely the case. A family history is also reported in some cases, while hypermobility or connective tissue disorders may be associated but are not yet confirmed risk factors.

Treatments available for retrograde cricopharyngeus dysfunction

Non-surgical treatment options

Primary treatment for RCPD is a Botox injection into the cricopharyngeus muscle (a muscle at the top of the oesophagus that contracts and relaxes to let food go down to the stomach). Botox injections can work both as a diagnostic test and a treatment.

By injecting Botox into the muscle, it allows the muscle to relax and let trapped gas escape. The treatment is typically done under general anaesthesia.

Most patients can burp and experience symptom relief within a week after a single injection. The effect of Botox usually lasts for a minimum of six to nine months.

If your symptoms recur, treatment can be repeated if necessary. In most cases, one injection is enough to cure no-burp syndrome permanently.

Surgical treatment options

If Botox injections are found to be ineffective or not a viable treatment option, surgery may be recommended.

A minimally invasive surgical procedure called a cricopharyngeal partial myotomy can be done to help release the gas from the stomach. During the procedure, an endoscope (a thin, long tube with a small camera at the end) is fed through your mouth and into the throat. Next, your surgeon will then make a cut partway through the cricopharyngeus muscle. This allows the muscle to relax, allowing air to exit the stomach and oesophagus.

Your consultant will discuss all the options with you, and together you can make an informed decision on what is best for you.

What to expect during your initial consultation

During your initial consultation, you will discuss your symptoms, medical history, family history, and various lifestyle factors with one of our expert consultants. This conversation will help your consultant determine what may be troubling you and whether you may need further investigation.

If retrograde cricopharyngeus dysfunction is suspected, you may be recommended for further tests such as a flexible nasopharyngoscopy, Botox injected via an upper esophagoscopy, or an electromyogram (EMG)-guided Botox injection.

Based on the results of your tests and your initial discussion, your consultant will recommend treatment options best you and your individual needs.

Learn more about one of our patient’s experiences getting their RCPD diagnosis and treatment at Circle Health Group here.

Retrograde cricopharyngeus dysfunction FAQs

Is RCPD dangerous?

RCPD is usually not dangerous, but it can be extremely uncomfortable and affect day-to-day life. However, the condition can cause intense pain, and there may be effects or complications researchers are not aware of yet.

What foods make RCPD worse?

There isn’t solid evidence that specific foods directly trigger RCPD.

However, many people find that large meals, carbonated drinks, fizzy drinks, and foods that make bloating worse can aggravate symptoms. Greasy, spicy, and rich foods may also make the pressure and discomfort feel worse.

Eating smaller meals and avoiding trigger foods can potentially help prevent severe symptoms from flaring up.

Why choose Circle Health Group for retrograde cricopharyngeus dysfunction treatment?

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suits your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for retrograde cricopharyngeus dysfunction, book your appointment online today or call a member of our team directly.

Clinical sources and further reading

1. Retrograde Cricopharyngeus Dysfunction (R-CPD/No Burp Syndrome), Yale Medicine
2. Retrograde cricopharyngeus dysfunction, MedicalNewsToday
3. Think You Have No-Burp Syndrome? Here’s What We Know About This Rare Condition, Cleveland Clinic
4. No-Burp Syndrome: Bringing Back the Burp, Johns Hopkins Medicine