Retrograde Cricopharyngeal Dysfunction (R-CPD) is a medical condition that causes an inability to burp. It was recently described by Dr. Robert W. Bastian of the Bastian Voice Institute in Chicago, who identified the cricopharyngeal muscle as the cause of the problem.

Who develops R-CPD and what causes it?

Most patients are between 20 and 30 years old. Many patients have had symptoms since childhood but were not diagnosed.

R-CPD is considered a problem related to the cricopharyngeus muscle (CP muscle, also known as the upper esophageal sphincter). The CP is a circular muscle located at the top of the esophagus. Normally, it remains in a tight and closed state to protect the throat from the contents of the stomach and esophagus. It is not consciously controlled.

When we eat and drink, the CP muscle temporarily relaxes to allow food from the throat into the esophagus before tightening and closing again. During burping, the CP muscle relaxes due to pressure in the upper esophagus to release trapped gas.

The underlying cause of R-CPD is unknown, but it appears to be a problem with the relaxation reflex of the CP muscle in response to esophageal pressure, leading to an inability to burp while not affecting the ability to eat. It differs from normal cricopharyngeal dysfunction, which also causes swallowing difficulties (dysphagia).

Why do the symptoms of R-CPD occur?

Patients with R-CPD may have mild to severe symptoms. Typical symptoms include:

Inability to burp

Pressure sensation in the upper neck and lower chest area

Accompanying loud gurgling noises, which can be socially embarrassing

Chest pain and/or discomfort in the stomach area

Excessive bloating in the abdominal area

Excessive gas or flatulence

Painful hiccups

Some affected individuals also report difficulty vomiting.

The above symptoms appear to worsen with the consumption of carbonated beverages such as beer or mineral water and sometimes with strenuous physical activity.

How is the diagnosis of R-CPD made?

Patients have often consulted multiple doctors to complain about these symptoms, but since it is a newly described disorder, it often goes unrecognized or is mistakenly diagnosed as gastroesophageal reflux disease (GERD). The diagnosis is typically made by a phoniatrician/ENT specialist who has expertise in recognizing and treating the condition. The phoniatrician/ENT specialist will conduct a detailed medical history and clinical examination to confirm the diagnosis and exclude other possible structural causes. This may involve an examination of the throat using a small flexible camera (laryngoscopy) inserted through the nose under local anesthesia.

How is R-CPD treated?

The treatment aims to exclude more serious pathologies of the throat and esophagus through visualization while performing a procedure to reduce the tension of the muscle, allowing it to relax during burping. The treatment is usually done under general anesthesia, where in some cases, biopsies can be taken. Subsequently, a rigid endoscope is used to expose the CP muscle, where it can be inspected and treated. At this point, a muscle relaxant medication called B0T0X is typically injected into the CP muscle, although surgical division of the muscle using a laser (myotomy) is also an option.

Schedule an appointment

To make an appointment, you can reach us by phone at 01752920000, contact us via WhatsApp, or send us an email at contact@thevoiceclinic.de.

Alternatively, you can also visit us directly (please make an appointment in advance):

TheVoice Clinic

Medical Center for Voice Disorders, Swallowing Difficulties, Respiratory Diseases, and Laser Therapy

Dr. med. A. Nasr

Bahnhofstraße 22

71034 Böblingen

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