"No-Burp Syndrome", AKA R-CPD: What Happens When You Can't Burp?

What happens if you can’t burp? You might think that sounds quite nice – burping is not the most pleasant or socially acceptable bodily function, after all, at least not in most cultures. But it’s also necessary, and for the community of “no burpers” out there, the lack of it comes with an array of unpleasant symptoms that until as recently as 2019 didn’t even have a medical name. Now, it’s been recognized as a condition called retrograde cricopharyngeal dysfunction (R-CPD) – and even more excitingly, doctors think they’ve hit on an effective treatment.

To understand the phenomenon of “noburp”, as the condition became known among the grassroots community of patients on Reddit , we need to understand a bit about how the esophagus normally works.

Inside the throat is a ring of muscle called the cricopharyngeus muscle. Most of the time, the muscle is contracted. You don’t feel it – it’s just there. Every time you swallow, the cricopharyngeus muscle briefly relaxes so that food and drink can pass into the esophagus. When you have to expel gas in a burp, that same muscle usually relaxes again – but in people with R-CPD, it doesn’t work like that.

Gas buildup in the stomach is a normal part of digestion. But if the cricopharyngeus muscle doesn’t open, that gas can’t escape in the usual way.

This causes the symptoms that Reddit users began to describe to each other: abdominal bloating, gurgling noises in the throat or chest, and excessive flatulence. Most notably, this community of people had a strange thing in common: the vast majority of them could not remember ever being able to burp.

“What's so cool is young people started talking about it on social media and helped each other realize what they all had so they could get the relief they needed,” said Dr Michael Pitman, Chief of the Division of Laryngology at Columbia University Vagelo College, on Columbia University Irving Medical Center's website .

Many people who have now been identified as having R-CPD dealt with these symptoms for decades without any definitive answers. Some were misdiagnosed with other conditions, like irritable bowel syndrome . But once you know what you’re looking for, Pitman says, R-CPD is strikingly easy to spot. “It's so severe and the diagnosis is straightforward.”

It’s not necessarily something people discuss often, so those with the condition might go for years not realizing that never burping at all is not normal. Once they become aware of R-CPD or stumble across the Reddit community, everything quickly falls into place.

The first description of what we now know as R-CPD was made in 1987 , but after that there was a long gap with precious little scientific discussion about the condition. Then, in 2019 , a 51-patient-strong case series was published that coined the term R-CPD and discussed the effectiveness of a potential treatment. The authors found that a Botox injection into the dysfunctional muscle was enough to help all 51 patients “retrain” the ability to burp, possibly forever.

Botox, or botulinum toxin, is usually associated with anti-wrinkle injections , but it also has some important medical uses . Because it’s used so widely, a lot was already known about its safety and efficacy before it was ever used to treat R-CPD.

“Botox is common for laryngeal disorders . It's just new for this syndrome,” said Pitman, whose clinic is now one of the leading centers offering this treatment. In Pitman’s experience, most patients get a permanent fix from a single shot, and those observations are backed up by other recently published data .

A big barrier that remains, though, is awareness. A 2023 study pointed out that 90.38 percent of survey respondents with the condition – users of the Reddit forum who were surveyed – had received “insufficient assistance” when they had sought help from a primary care provider.

Given the substantial impact of the symptoms R-CPD causes, including social and emotional effects, and the fact that Botox treatment appears to provide relief for most, greater awareness of the condition could be life-changing for people who may still be suffering in silence.

Burping after a meal might get you the odd side-eye at the dinner table – but instead of being embarrassed, just be thankful that your cricopharyngeus muscle is in good working order.

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The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.