Retrograde Cricopharyngeal Dysfunction – “No Burp Syndrome”


Symptoms of Retrograde Cricopharyngeal Dysfunction (R-CPD) or the “No Burp Syndrome” are the lifelong inability to burp, chest pain and discomfort, stomach bloating, gurgling sounds coming out of your throat and flatulence. These symptoms make social social interaction very stressful. People with this problem often have to watch what they eat or drink as certain foods may exacerbate the symptoms. Carbonated beverages and beer are two things many patients comment they must avoid.


The diagnosis is made mostly on history. If you have the above symptoms it's quite likely you are suffering from retrograde cricopharyngeal dysfunction or the “No Burp Syndrome”


Treatment of this disorder is botulinum toxin or Botox injection of the cricopharyngeus muscle. This is performed under general anesthesia using a minimally invasive approach through the mouth. The surgery is day surgery that takes approximately 30 to 60 minutes. After surgery, there are no activity restrictions although you will want to take it easy for the rest of the day because of the anesthesia. Alternatively, we are also performing the injections in the office.  They take 30-60 seconds and are performed without general anesthesia, so there is no down time.  We are now conducting a prospective research trial to compare the effectiveness of these two different injection techniques.


Patients will start to notice an improvement in their symptoms within two to three days of their surgery. This will continue to improve over the next one to two weeks. During this time, patients can eat normally and continue a regular diet but they may experience the need to swallow a little harder than usual to get some solid food down. Nearly 100% of patients will experience improvement with this treatment. Only 20% of patients will need a second Botox injection. It is very rare to have another recurrence of symptoms after the second injection. When this does happen, a partial endoscopic cricopharyngeal myotomy will be performed for permanent treatment.