INABILITY TO BELCH
HOW DO YOU CONTACT US?
Please complete the 'questionnaire before treatment' at the top of the page and return it to us by email at secr.nko@azdelta.be. This will enable us to assess whether your condition is eligible for the procedure. We will then contact you to arrange an appointment if appropriate.
Complaints of "inability to burp," whether or not accompanied by other problems such as gargling, bloating, pain in the chest or stomach area, or flatulence fit a syndrome called retrograde cricopharyngeal dysfunction (R-CPD). These problems require a multidisciplinary approach from the ear-nose-throat specialist and the gastrointestinal specialist.
WHAT IS RETROGRADE CRICOPHARYNGEAL DYSFUNCTION?
Retrograde cricopharyngeal dysfunction (R-CPD) is a syndrome of the m. cricopharygeus, also known as the upper esophageal sphincter. This closing muscle in the throat will not relax when air comes back up from the stomach, preventing the air from escaping. As a result, the air moves up and down the esophagus, eventually sinking back into the stomach and intestines, where it causes symptoms.
The disease consists of several possible symptoms:
1) inability to burp;
2) gurgling, disturbing sounds;
3) some type of pain/discomfort low in the neck, chest or abdomen and this often accompanied by the feeling of a bloated abdomen;
4) excessive flatulence.
Some patients also have difficulty in vomiting. Very many of these patients have had this syndrome all their lives, but only become aware of it during puberty. People often experience very painful hiccups as well. Another symptom may be increased saliva production, especially in stressful situations.
Read more here.
HOW ABOUT THE EXAMINATION?
You will fill out a questionnaire beforehand which will be reviewed with the doctor. A clinical examination of the nose, throat and ear is then performed, including an examination of the larynx, vocal cords and esophagus (laryngoscopy). This examination serves to exclude abnormalities of the larynx.
An objective test was developed in collaboration with colleagues from the Gastroenterology and Hepatology Department at UZ Leuven and St. Lucas Bruges. This test involves measuring pressure (manometry) in the esophagus. On this examination of the esophagus the doctor can see these abnormalities after eliciting the abnormalities by drinking sparkling water, which allows the doctor to confirm the diagnosis.
THERAPY
Once diagnosed, treatment consists of an injection of botulinum toxin (Botox) into the upper esophageal sphincter muscle. This allows the sphincter to relax again. This procedure is done under general anesthesia in the day hospital. This procedure requires a half-day hospital stay. You must arrive on an empty stomach.
Improvement can occur mostly from one to six days after the injection. When the effect of the botox is felt, drinking carbonated water can be used to train the muscle. We also recommend that you experiment to see which movement or position allows the air to escape upward most easily—for example, by turning your head to the left or right. No guidelines are available yet, but this is currently being studied. A simple injection can bring about a permanent cure in a lot of people (70%), however, unfortunately not yet in everyone. If the treatment is ineffective, a (new) esophageal manometry with a water-spray test is recommended to determine the possible cause of the lack of results.
THEREFORE, WE LIKE TO FOLLOW UP WITH YOU AFTER THE PROCEDURE.
One week and one month after the procedure, you will be asked to fill out another short questionnaire to assess the results. You will receive a message from the hospital (via email or text message) regarding this. The same will happen after six months and one year. You can also find these questionnaires at the top of this page. If you did not receive a message, please fill out this questionnaire on top of this page and send it to us via email.
FREQUENTLY ASKED QUESTIONS
WHEN CAN I EXPECT AN EFFECT?
Normally between 1 to 6 days after the procedure.
WHAT CAN I DO TO PROMOTE THE EFFECT AND RELIEVE DISCOMFORT?
The moment you feel the air coming up, you can burp mindfull:
Feel where the air is and assume a position where the air can come up more easily, e.g., head back, larynx down, possibly turning the head to the left or right.
As soon as you feel the air can come up, you may practice this with carbonated drinks.
WHAT SIDE EFFECTS CAN I EXPERIENCE?
You may experience difficulty swallowing solid food.
What we recommend:
- drinking water to flush out food,
- eating mindfully: taking small bites and chewing well.
WHAT ARE OTHER POSSIBLE SIDE EFFECTS ALREADY MENTIONED?
Please note that these are possible symptoms you may experience. This does not mean that everyone has them, but they CAN occur. It is unpredictable in who does and who does not.
Nausea, feeling of food coming up, some more acid reflux.
What do we recommend?
These symptoms are all only temporary, certainly transient. Don't be alarmed, wait and see. Do what you feel most comfortable with. The side effects will all pass.
WHAT IF YOU EXPERIENCE INSUFFICIENT EFFECT AFTER THE PROCEDURE?
If you have not experienced improvement at six weeks after the procedure, it is best to schedule a check esophageal manometry with sparkling water provocation. Depending on the result, a second injection can be scheduled. Please contact our secretary again (secr.nko@azdelta.be).
WHAT OTHER GASTROINTESTINAL LIVER DISEASES CAN OCCUR TOGETHER WITH R-CPD?
You may suffer from other gastrointestinal liver diseases besides R-CPD such as heartburn/reflux.