RCPD is believed to result from dysfunctional nerve control of the upper esophageal sphincter involved in burping. As a result, the upper esophageal sphincter fails to relax, preventing excess air in the stomach and esophagus from being released. This causes excessive gas to accumulate in the stomach, esophagus, and intestines.

The main symptoms of RCPD include:

• Inability to burp
• Abdominal fullness or chest discomfort when feeling the urge to burp but being unable to do so
• Gurgling noises in the upper chest or lower neck caused by air moving within the upper esophagus
• Excessive flatulence
• Difficulty vomiting because the upper esophageal sphincter does not open easily

Doctors diagnose RCPD by reviewing the patient’s medical history, performing a physical examination, and conducting an esophageal manometry to confirm the diagnosis and rule out other esophageal disorders that may have similar symptoms.

During an esophageal manometry, an additional assessment may be performed in which the patient drinks carbonated beverage. This allows the physician to observe whether gas rises into the esophagus during the urge to burp and whether the upper esophageal sphincter fails to open, preventing the release of air.
 

Treatment with botulinum toxin (Botox) is appropriate for patients whose symptoms significantly affect their quality of life. For example, the inability to burp results in chronic bloating or excessive gas accumulation in the digestive tract.

The physician will evaluate each patient's symptoms and determine whether this treatment is appropriate on an individual basis.

RCPD can be treated by injecting Botox into the upper esophageal sphincter during an upper gastrointestinal endoscopy. Patients receive sedation before the procedure so they remain asleep and do not experience pain.

The physician then inserts the endoscope into the esophagus and injects Botox into the upper esophageal sphincter muscle to help it relax. Following treatment, patients can return home the same day, similar to a routine upper gastrointestinal endoscopy.

1. The patient is sedated before the procedure.
2. The physician uses an endoscope to visualize the upper esophageal sphincter and guide the injection needle.
3. Botox is injected into the upper esophageal sphincter muscle.
4. After the injection, the patient is closely monitored for any side effects or complications.
5. The patient returns for scheduled follow-up appointments to evaluate the treatment outcome.

The risks associated with Botox injection performed during upper gastrointestinal endoscopy are very low. However, if the injection affects the nerve supplying the vocal cords, it may result in hoarseness or temporary vocal cord dysfunction. For this reason, the procedure should be performed by an experienced endoscopic Botox injection specialist.

Most patients are able to burp and experience significant improvement within a week after the Botox injection. A small number of patients may require a second injection if some symptoms persist.

Long-term follow-ups have shown that Botox treatment can provide lasting relief for the symptoms. Most patients continue to experience good outcomes beyond one year without recurrence of symptoms or the need for additional injections.

The Gastrointestinal Motility Center at Bumrungrad International Hospital has a team of specialists experienced in diagnosing and treating disorders affecting the upper gastrointestinal tract and esophagus disorders. Our physicians provide individualized consultations and personalized treatment plans based on each patient's symptoms and needs.

After treatment, patients should carefully follow their physician's instructions. During the first few weeks, it is common to experience frequent, forceful burping, and some patients may notice increased acid reflux. These side effects usually improve gradually over time. If you are concerned or experience significant side effects, you should consult your physician for advice.

Retrograde Cricopharyngeal Dysfunction (R-CPD): A Disorder Caused by Upper Esophageal Sphincter Dysfunction | Bumrungrad International Hospital

Retrograde Cricopharyngeus Dysfunction (R-CPD/No Burp Syndrome) | Fact Sheets | Yale Medicine

Retrograde cricopharyngeal dysfunction (RCPD) - inability to burp: treatment with Botox injection | ENT & Audiology News

Trapped No More | Johns Hopkins Medicine