What is retrograde cricopharyngeus dysfunction?

Retrograde cricopharyngeus dysfunction (R-CPD) is a somewhat newly described syndrome that could explain an inability to belch or burp. It can also be associated with other symptoms including but not limited to: loud, gurgling noises, and chest and abdominal pain/distention.

Researchers and practitioners believe the condition is due to a malfunction of the cricopharyngeus (CP) muscle (also known as the upper esophageal sphincter or UES). In a typical person, this muscle is tightly closed and protects the throat from the contents of the stomach. It is not a muscle that can be consciously controlled. As we swallow food or drink, this muscle relaxes to allow the passage of food into the esophagus. To belch, pressure in the esophagus relaxes the CP muscle from below in order to release the built-up gas from the stomach.  R-CPD appears to be an issue with the relaxation function of the CP muscle, where it is unable to fully relax to release the trapped gas – thus making it impossible to burp or belch.

Can It Be Treated?

In a study conducted by Dr. Robert Bastrian and Melissa Smithson, MS, PA-C, they observed the use of botulinum toxin (BT) injection into the cricopharyngeus muscle (CPM) for both diagnosis and treatment of R-CPD. What they found was that all 51 patients in the study achieved the ability to belch and experienced relief of associated symptoms. These results are not as commonly seen with other practitioners.


R-CPD is a relatively newly described explanation for a poorly understood belching syndrome. It is controversial. If you think you could have R-CPD, speak with your doctor to discuss your treatment options.




Author Claire Littlefield

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