Social media users and medical specialists have been raising awareness of a rare condition that stops people from burping, but treatment options remain limited and costly.
Eating out with friends was a constant source of anxiety for Dulcie, a 23-year-old research student from the UK. Her throat would gurgle loudly, and her chest would tighten as gas painfully expanded in her stomach.
Then one night, while scrolling on her phone, she saw a video about a rare condition – and suddenly her physical discomfort made sense: she’d never been able to burp.
Retrograde cricopharyngeal dysfunction (R-CPD), also known as “no-burp syndrome,” was formally identified as a medical condition in 2019, following a case series published in the National Library of Medicine by Dr Robert Bastian of the Bastian Voice Institute in the US state of Illinois.
Awareness has grown since, giving sufferers a name for their affliction and online spaces to connect – most notably the noburp subreddit, which has nearly 35,000 members.
“Now I know what R-CPD is, I blame it for many of the barriers to generally good physical and mental health that I face,” Dulcie told Euronews Health, explaining that she also believes the condition could be the cause of her severe phobia of vomiting due to the build-up of pressure in the chest that sometimes leads to nausea.
“It is actually maddening how something many consider so unimportant, burping, can actually have such a profound effect on the quality of somebody’s life,” she added.
Despite growing evidence of its mental and physical toll, R-CPD remains widely unrecognised amongst healthcare professionals due to research being in its infancy – and societal perceptions around burping.
“There is a treatment for the condition, but it is not NHS [the UK’s National Health Service] approved yet because lots of doctors don’t know about the condition, or don’t consider it to be a problem,” Mr Yakubu Karagama, laryngologist at Guy’s and St Thomas’ NHS Foundation Trust, told King’s Health Partners.
“It’s currently being seen as a social issue, but it’s not a social issue it’s a health issue”.
This lack of medical acknowledgment has led many people to self-diagnose online and seek out costly treatment options.
Why can’t some people burp?
For most of us, burping is as natural as breathing, aside from the occasional post-fizzy drink exorcism.
When excess air accumulates in our stomachs, the lower oesophageal sphincter – a valve that acts as a barrier between our throat and stomach – relaxes. This allows air to move up through our oesophagus and out of our mouths, resulting in a (hopefully) satisfying belch.
In those with R-CPD, it’s thought that the cricopharyngeus muscle, an entry valve located in our upper oesophagus, is unable to relax as it should, leaving the air trapped.
“That retrograde dysfunction, that absence of relaxation of that upper sphincter, so that the air can’t get out, leads [people] not to be able to burp. As a consequence, the air is trapped in their oesophagus, so that often they’ll feel a substernal pressure,” said Dr Lee Akst, a leading laryngologist at Johns Hopkins Medicine.
“The associated symptoms are, I feel bloated, I have a gurgling sensation, I have chest or abdominal discomfort, and I feel as if I’m more flatulent than my friends who can burp because of the physical consequences of the air being trapped”.
For 41-year-old *Amelia, who has been formally diagnosed with R-CPD, these side effects led to a complete avoidance of public eating and drinking.
“I couldn’t drink with my food, couldn’t enjoy nights out or meals out. It was embarrassing, painful and socially debilitating”.
A recent study conducted by Texan academics found that those unable to burp were more likely to struggle with anxiety, depression, and embarrassment, along with facing negative impacts on their work and relationships.
“Sitting up at my desk for full days is actively painful,” Dulcie said.
“It means I can’t do anything in my evenings because I have to lie down for the gurgles and pain to subside”.
Is there a cure for ‘no-burp syndrome’?
Usually diagnosed with an endoscopy, the main treatment available for R-CPD is botulinum toxin (botox) injections into the cricopharyngeus muscle, relaxing it and allowing air to pass through.
Only a limited number of doctors currently offer the procedure, which costs upwards of £3,000 (€3,621) through select private healthcare providers, according to a UK petition calling for funding on the NHS.
This can sometimes be covered by insurance, according to anecdotal posts on the noburp subreddit, although there’s no guarantee due to the condition still being so new and unknown.
The botox lasts about three months, but during that time, patients can achieve longer-term results by relearning control of their upper oesophageal sphincter, according to Akst at Johns Hopkins.
“About 90 per cent of people who are treated begin to burp, and about 90 per cent of those people who begin to burp can continue to burp even after six months or so, even after the drug is gone, because they’ve hopefully learned some degree of volitional control over that valve”.
As with all medical treatments, there are some risks.
The primary function of the cricopharyngeus muscle is to prevent acid reflux, which could temporarily worsen after being relaxed, Akst explained. He also noted that some patients’ swallowing becomes more hesitant.
“The oesophagus is trying to squeeze the food down, but that valve above it is open. It’s like trying to squeeze a tube of toothpaste if you’ve cut the back end of the tube off. You can’t build the same pressure wave in only one direction. And so, often after this surgery, people feel as if their swallowing is slower,” he said.
However, those Euronews Health spoke to who have had the procedure found the benefits far outweigh the costs.
“Best money I’ve ever spent,” Amelia said, adding that she paid £5,000 (€6,038) six years ago.
“There’s so much I can do now that I couldn’t do before. I can enjoy meals out, sit in quiet rooms, and rarely fart. Burping is subconscious to me now, just a normal part of life,” she said.
Meanwhile, Dulcie is booked in for treatment in the UK soon.
“If this works, it will change my life. I’ll be able to eat a full meal out with my friends without having to retreat home to gurgle in peace afterwards. I’ll be able to drink a lemonade or a beer without feeling like I might explode. I’ll be able to get into normal eating habits,” she said.
For those that can’t afford the treatment, certain head and neck exercises can sometimes help encourage burping.
“Practice with chin postures, either tucking it down or bringing it forward or turning it left or turning it right. And see if you can turn that little kind of croaky, slow motion gas escape into an honest to goodness burp and try to practice it in that fashion,” Akst said.
“But again, success rates are fairly anecdotal. There’s not one regimen that everybody uses”.
Sam, a 31-year-old parcel sorter from France, found relief by consistently practicing physical shaker exercises, intended to improve swallowing.
“My first burp was a micro burp and was not very spectacular. But when I did a second one a long time later, then I started to have hope,” he said.
“I’ve learned to control [burping] more calmly and today it’s much better. I burp after my meals, after my drinks, all day long. I feel much lighter,” he added.
* Name has been changed at the request of the interviewee.
Those we spoke to with R-CPD agreed to talk to Euronews Health about their experiences but did not want their surnames to appear in print for privacy reasons.
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