This is what happens when you cannot burp, ever

It sounds like a setup for a joke, but people who have no-burp syndrome are miserable.  

In most people, a muscle in the throat relaxes briefly every time we swallow, allowing food and drink to flow into the esophagus. We don’t feel it. It just happens. When we burp, the same muscle relaxes to let the air out. The rest of the time this muscle—the cricopharyngeus—is contracted.  

In people with no-burp syndrome, the cricopharyngeus muscle never relaxes for burping. The condition’s medical name is retrograde cricopharyngeus dysfunction (R-CPD) and it wasn’t discovered until 2019.  

Until recently, no-burp syndrome sufferers—who experience syndrome-induced social anxiety on top of pain—were mistakenly diagnosed with conditions like acid reflux (AKA, heartburn), irritable bowel syndrome, or small intestinal bacterial overgrowth. Because of misdiagnosis, they never got relief because no treatment was successful. 

“No-burp syndrome is a whole new phenomenon,” says laryngologist Michael Pitman, MD, chief of the Division of Laryngology at Columbia University Vagelos College of Physicians and Surgeons. “What's so cool is young people started talking about it on social media and helped each other realize what they all had so they could get the relief they needed.” 

Pitman now leads one of the primary treatment centers in the field.  

Why do people burp? 

We burp to release gas that builds up in our stomachs during the digestion of food, when food is breaking down, or because we have swallowed air. 

Signs of no-burp syndrome 

No-burp syndrome is easy to identify. Almost 100% of people who self-diagnose and make an appointment with Pitman do indeed have the syndrome. "It's so severe and the diagnosis is straightforward,” says Pitman.  

Most no-burp syndrome sufferers have all of these symptoms: 

1. Never burping, ever, or for as long as you can remember.  
2. Bloating.  
3. Gurgling sounds in the throat.  
4. Flatulence. 

These are lifelong, never-ending symptoms. People experiencing one night of discomfort because of something they ate do not have a syndrome.

No-burp syndrome treatment 

You can't fix no-burp syndrome with diet, exercise, or training yourself to burp. Following a consultation, a Botox injection to the cricopharyngeus muscle is all that’s needed to produce maximum results. 

Botox shots in the throat are not experimental and not a new procedure. “Botox is common for laryngeal disorders,” says Pitman. "It's just new for this syndrome." The Botox weakens the muscle so it relaxes and allows air to escape, as happens for people without the syndrome. For most patients, the fix is permanent. Only about 20% of patients need a second shot. In the hundreds of people Pitman has treated, only one patient needed a third (and different) treatment. 

The injection is a simple, quick, and effective procedure that can be done in the office. Pitman and his team are launching a study to look at whether patients do better after treatment in the office or in the operating room.