No Burp Syndrome

Retrograde Cricopharyngeus Dysfunction (RCPD)

The Texas Voice Performance Institute at UTHealth Houston provides comprehensive care for patients experiencing “no-burp syndrome,” formally known as Retrograde Cricopharyngeus Dysfunction (RCPD). RCPD is a relatively uncommon condition in which affected patients are unable to burp. For the majority of these patients, symptoms have usually been present for as long as they can remember.

Symptoms

Aside from the principal symptom of an inability to burp, RCPD patients will often suffer from these additional complaints:

  • Gurgling noises from the throat or neck, often uncontrollable, and audible to others
  • Uncomfortable pressure sensations in the chest or neck
  • Abdominal bloating
  • Excessive flatulence


Many RCPD patients struggle with social interaction because of these symptoms, and will often have to carefully watch what they eat or drink to avoid worsening their symptoms, like carbonated beverages and beer.

Diagnosis and office-based care

RCPD is primarily a clinical diagnosis, meaning that your doctor will likely be able to diagnose you based on your symptoms after performing a standard office evaluation and physical exam. Oftentimes, a flexible laryngoscopy is part of that exam. This relatively painless procedure takes less than a minute and allows your physician to get extra information about your anatomy. While uncommon, additional testing may be required depending on your doctor’s evaluation.

Treatment

Botulinum Toxin (Botox®) injection to the Cricopharyngeus muscle remains the standard treatment for this condition and is curative in 80-90 percent of patients. This quick injection is performed through the mouth, and is traditionally done in the operating room under general anesthesia. The procedure can also be performed in the office with local anesthesia for select patients who are deemed candidates for this option.

FAQ

RCPD has likely existed for a very long time, and there is a good chance you know several people who have struggled quietly with these symptoms. It is not unusual to hear from RCPD patients who had to undergo numerous, non-diagnostic tests, or who were met with disbelief from their doctors after seeking care. It wasn’t until just recently in 2019 that Dr. Robert Bastian published the first scientific paper on the topic, formally identifying these symptoms as a new medical condition called RCPD.
The cricopharyngeus muscle is the circular gate between the throat and the esophagus. It normally remains tightly closed, but opens to allow the passage of foods and liquids while swallowing. It should also open to allow the release of excess gas in the form of a burp. In RCPD patients, this does not happen, and gas becomes trapped in the esophagus or stomach leading to many of the symptoms listed above.

Meet the Physician

Andrew G. Tritter, MD

Andrew G. Tritter, MD

Andrew G. Tritter, MD, is an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery. He directs the department’s laryngology division and the Texas Voice Performance Institute. His experiences have given him extensive training in voice, airway, and swallowing disorders for patients of all ages. His clinical interests include care for the professional voice, vocal fold paralysis, spasmodic dysphonia, management of early-stage laryngeal cancer, benign vocal fold lesions, respiratory papillomatosis, tracheal stenosis, laryngeal stenosis, swallowing disorders, chronic cough, and numerous other conditions affecting the throat.

UT Physicians Otorhinolaryngology - Texas Medical Center

6400 Fannin Street, Suite 2700
Houston, TX, 77030