Burping isn’t the most glamorous of topics, and it’s one of those things that most of us do without a second thought. In terms of our health, it plays an important role, allowing air trapped in the upper part of our stomach to be released, stopping the stomach from overinflating and relieving any build-up of pressure in the process.

But for some people, burping isn’t just difficult, it’s nigh on impossible, due to a condition called retrograde cricopharyngeal dysfunction (R-CPD), more commonly known as ‘no-burp syndrome’. And the main symptom is exactly what you might expect – an inability to burp. At all.  

While the condition is thought to be uncommon, there’s no shortage of people talking about the condition online: on TikTok, the #NoBurpSyndrome hashtag boasts 8.6 million views. So, what is no-burp syndrome? How common is it? And are there any treatment options? 

No-burp syndrome is caused by an issue within the upper oesophageal sphincter, a high-pressure area located between the throat and the oesophagus (the tube that takes food down to the stomach).

In particular, it’s thought to have something to do with the dysfunction of the cricopharyngeal muscle, which sits at the top of the oesophagus. This muscle is designed to stop food and drink from rising back up into the throat after it’s been consumed: it’s shut tight until we swallow, at which point it relaxes and allows food to pass before closing up again. The same happens when material rises up from the stomach, such as gas – it relaxes, the gas is released, and then it closes up again to prevent anything else from escaping.

But in people with R-CPD, this muscle doesn’t work quite right. It relaxes to let food, drink and air go down, but it doesn’t relax to let excess air out, which is why people with the condition are unable to burp. 

Currently, doctors aren’t quite sure what causes no-burp syndrome. “The condition is known to affect both children and adults, and many who have the condition have never burped,” Professor Martin Birchall MD, a leading expert in laryngology at King Edward VII Hospital, explains.

“It is documented that some people with R-CPD have experienced a traumatic event, illness or have undergone surgery, but there is really no single known cause.”

Some people also believe R-CPD can be caused by anxiety – specifically, a fear of vomiting, known as emetophobia – although more research is needed to discern whether this could play a role. 

Alongside not being able to burp, R-CPD can trigger a number of uncomfortable symptoms. These include:

• Bloating
• Stomach discomfort
• Excessive wind
• Painful hiccups
• Pressure in the throat
• Gurgling noises in the throat
• Nausea

Some patients with R-CPD may also develop emetophobia, adds Mr Yakubu Karagama, a consultant ENT surgeon, laryngologist and head of the voice, airway and swallowing service at Guy’s and St Thomas’ NHS Foundation Trust. This is because the cricopharyngeal muscle is forced open during vomiting, rather than relaxing as it would in people without R-CPD.

A study published at the end of last year found a link between no-burp syndrome and mental health conditions such as anxiety and depression, largely due to the lack of research and recognition surrounding R-CPD. 

While R-CPD is a recognised health condition, the true number of people living with no-burp syndrome is not known, simply because many people don’t seek medical help or don’t realise it’s an official condition.

Currently, it’s classified as rare, but Mr Karagama believes that could change. “It is more common than we realise,” he says. “We don’t know the incidence right now because it is still a fairly unknown condition.”

It’s also not known whether no-burp syndrome has any ties to gender, but it has been identified across all age groups and has even been shown to run in a family. 

The good news is that, yes, there are treatment options. The only issue is that they are limited in number and some of the most effective can be invasive.

“The ones available do vary,” says Professor Birchall. “For example, the ‘supragastric belch’ method is a technique used to manually release trapped air, where you learn how to create a burp by swallowing air and then releasing it. Speech therapy or physical therapy has also been used to help relax the muscles to aid burping.”

“In more severe cases, surgical intervention might be required, or a Botox injection into the cricopharyngeal muscle. Botox is used to relax the muscle, so people can burp and, in turn, relieve symptoms.” 

He continues: “It should be stressed though that surgical treatment and Botox for this condition should only be given by experienced laryngologists or gastroenterologists, as it can have side-effects.”

It’s worth noting that due to the condition’s relatively unknown nature, some of these interventions – including Botox – are not available on the NHS. 

However, it’s important to pay a visit to your GP first to get that initial diagnosis if you’re struggling. This will allow them to rule out any similar conditions such as gastroesophageal reflux disorder (GERD), oesophageal motility issues or food intolerance and see what treatment options are available.

Image: Getty