These people can’t burp. It’s painful and embarrassing. (2023)

In 2019, the condition that patients often described as “no-burp syndrome,” was officially named in the medical literature: retrograde cricopharyngeus dysfunction, or RCPD. Despite the name, many doctors still don’t know much about it. Patients say they’ve spent months or years wrongly diagnosed with acid reflux, irritable bowel syndrome (IBS) or intestinal overgrowth, among other things.

It’s unclear how widespread no-burp syndrome is, or why it happens, said Robert Bastian, director of the Bastian Voice Institute in Downers Grove, Ill., who is credited with coining the name RCPD.

The condition is caused by a malfunctioning cricopharyngeus muscle, which essentially acts as a gate between the esophagus and the throat. The muscle stays tightly closed but opens while swallowing to allow the passage of foods and liquids. It’s also supposed to release the gas that comes back up.

But for people with RCPD, the muscle won’t relax enough to allow them to burp, and the gas gets trapped in the esophagus and stomach. Because of the excess gas, patients with RCPD usually experience uncontrollable gurgling sounds in their throat that others can hear. The gas causes bloating, excessive flatulence and painful pressure in the chest and neck.

But it’s the lack of burping that is the defining characteristic of an RCPD diagnosis.

“That is the cardinal symptom that has to be there,” said Andrew Tritter, director of the Texas Voice Performance Institute in Houston. “That gas buildup can be very uncomfortable and painful.”

Some patients on Reddit have discussed feeling so desperate they try to stick their fingers down their throats to release the burp. Doctors say the method is risky and can damage vocal cords or lead to choking.

“People don’t realize how debilitating it can be,” said Ace Thomas, a 31-year-old university worker in Huntsville, Tex. “I was in abject misery for most days. Bloating and dry heaving every day of your life is no fun.”

Stifled burps aren’t just painful. The condition can make social situations challenging. Some people with RCPD make sounds that interfere with daily life, such as gurgling or frog-like noises often described as “croaking.”

“People struggle and suffer through high school and college, and it’s a huge hit to social life because of the gurgling and the flatulence,” Bastian said.

Sufferers said they must constantly focus on how to minimize the bloating and gurgling, by cutting out certain foods and beverages and avoiding social situations in which they might be embarrassed.

“You kind of feel like you walk on eggshells or change your life around it,” Rhymer said.

When a failure to burp is your health problem, it’s also hard to explain to others that it’s a legitimate medical condition. When Thomas told his co-workers about his symptoms, they laughed at him, and some friends made jokes that he had “male morning sickness.”

Some people have success teaching themselves to burp through Shaker exercises, which involve lying flat and tucking your chin to your chest. The most effective treatment for RCPD is botulinum toxin injection, or Botox. Botox is used to relax forehead muscles to smooth wrinkles, to prevent migraines and stop excessive sweating. In the case of RCPD, general anesthesia typically is required to inject the Botox into the cricopharyngeus muscle, temporarily paralyzing it and essentially allowing it to reset.

Right after the procedure, patients may struggle to eat or swallow, and they may feel as if they have a lump in their throat.

But research shows the treatment is highly effective. In one study of 200 patients, 185 (93 percent) gained the ability to burp within a week of treatment. Fourteen others (7 percent) gained burping ability within four weeks. About 80 percent of patients were still able to burp after six months. The problem came back in a subset of patients who needed additional injections.

“It was a crazy release,” said Rhymer, who underwent the procedure in March. Within the first week after treatment, she was able to burp and has been what she describes as a “burping machine.” “I felt like it was an exorcism,” she said. “It was very loud and big and not what I expected to come out.”

Thomas expressed a similar feeling of satisfaction. “My whole life, I’ve had a lot of these issues and never knowing what it was, or doctors guessing IBS,” he said. “As soon as I burped, it all melted. It was satisfying.”

For people who have never or rarely experienced burping, living with it can also create issues.

Aleah Boehlen-Joosten, a 27-year-old in Kenosha, Wis., was suffering from abdominal pain for several months before she discovered the subreddit on no-burp syndrome. That’s how she learned about Bastian and the Botox treatment.

A few weeks after the procedure, she began vomiting during a yoga class. Vomiting can be a temporary side effect of the treatment. Some people with RCPD avoid the procedure because they have a fear of vomiting, known as emetophobia.

And for people not accustomed to burping, the belches can sometimes happen unexpectedly. “Every time I laughed, I would burp uncontrollably,” she said.

After a few months, she learned to control her burps. She said despite finding relief in burping, she was repulsed to learn that burps can have flavor.

“It tastes horrible,” she said. “No one warns you that it tastes like food. It was disgusting.”

Rhymer, Thomas and Boehlen-Joosten all found out about RCPD through Reddit. The subreddit r/noburp has over 20,000 “no-burpers” and is an active community where users chronicle their frustrations, compare experiences and provide guidance. Even Tritter is on the page, to serve as a “voice of reason” to help calm fears and reassure patients about whether treatments are appropriate.

Being able to commiserate with people who understand RCPD is validating for sufferers.

“I felt for a long time it was a lack of technique, and I just didn’t know how to burp,” Boehlen-Joosten said. “But it’s a diagnosable medical condition. It’s something that causes discomfort and suffering in extreme cases, so that validation was helpful.”

While social media is often the culprit in misinformation about medical conditions, the Reddit discussions have helped raise awareness about the condition, experts said.

“This has enabled so many people to get diagnosed and treated that wouldn’t have before,” said Sunil Verma, director of Voice and Swallowing Center at the University of California at Irvine School of Medicine. “As a whole, that’s a real positive.”

Now the challenge is finding people who have been wrongly diagnosed and the doctors who are treating them, Verma said.

“We need to find a way to let our surrounding physician community know about it,” he said. “Not just us that treat the majority of these patients.”

Finding treatment has brought enormous relief, Rhymer said.

“The condition seems like a minor thing. I’ve had people tell me I was so lucky because burping is kind of gross,” Rhymer said. But being able to burp, something “that many people in the world can naturally do, is life changing.”

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