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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.


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. 

Read more about the causes and treatment here.



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.

The doctor will then refer you to a specialized gastroenterologist (gastrointestinal specialist) to map the typical abnormalities of the sphincter in the throat using a pressure measurement (manometry). This is an examination of the esophagus on which the doctor can see these abnormalities after eliciting the abnormalities by drinking sparkling water, and which allows the doctor to confirm the diagnosis.



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.

Improvement can occur from 24 hours after treatment to over a period of 2 weeks.  When the effect of the botox is felt, drinking carbonated water can be used to train the muscle. A simple injection can bring about a permanent cure in a lot of people (65%), however, unfortunately not yet in everyone. Therefore, we like to follow up with you after the procedure.

One month after the procedure, you will be asked to fill out a short questionnaire again to measure the difference before and after the treatment.

Six weeks after the treatment, the gastroenterologist will repeat the pressure measurement of the esophagus to see if the typical abnormalities have disappeared after the procedure.

Six months and one year after the treatment, we will ask you to fill out a short questionnaire again, to check the evolution of your symptoms. These questionnaires can be found at the top of this page.

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