Retrograde Cricopharyngeal Dysfunction Australia – Inability to burp or Eructile Dysfunction
What is Retrograde Cricopharyngeal Dysfunction (R-CPD)?
Retrograde Cricopharyngeal Dysfunction (R-CPD) is a medical condition causing inability to “burp” or “belch”. It was described only recently by Dr Robert W. Bastian from the Bastian Voice institute in Chicago who identified the cricopharyngeal muscle as the source of the problem. Dr Bastian has developed a successful diagnostic and treatment pathway for people affected by R-CPD and was the first to publish a scientific paper on the topic in 2019 – Inability to Belch and Associated Symptoms Due to Retrograde Cricopharyngeus Dysfunction: Diagnosis and Treatment. Our doctors here at Sydney Voice and Swallowing – A/Prof Daniel Novakovic and Dr Thomas Stewart are among the first clinicians in Australia to have adopted Dr Bastian’s techniques and we have successfully treated numerous patients with this problem.
Who gets R-CPD and what causes it?
Most patients are aged between 20 and 30 years old. In our experience males are affected more frequently than females but it does occur across both genders. Many patients have had the symptoms since childhood have not been diagnosed or have only realised the symptoms are not normal after discussion with friends and peers.
R-CPD is thought to be a problem related to the cricopharyngeus (CP) muscle (also known as the upper oesophageal sphincter or UES). The CP is a circle shaped muscle which sits at the top of the food pipe or oesophagus. It normally sits in a tight and closed state, protecting the throat from the contents of the stomach and oesophagus. It is not under conscious control
When we eat and drink, the CP muscle relaxes temporarily, allowing food to pass form the throat into the oesophagus, before tightening and closing off again. When we burp, pressure in the upper oesophagus causes the CP muscle to relax in order to release built up gas.
The underlying cause of R-CPD remains unknown but it appears to be a problem with the relaxation reflex of the CP muscle in response to oesophageal pressure causing inability to burp but does not affect the ability to eat food. It differs from regular Cricopharyngeal dysfunction which also causes difficulties swallowing (dysphagia)
The medical terminology for burping is “Eructation”. We therefore consider R-CPD to be a form of “eructile dysfunction”
Why are the symptoms of R-CPD?
Patients affected by R-CPD can have symptoms which range from mild to severe. Typical symptoms include:
- Inability to burp or belch
- A pressure sensation in the upper neck and lower chest
- Associated loud gurgling sounds which can be socially embarrassing
- Chest pain and/or discomfort in the stomach region
- Excessive bloating in the abdomen / belly
- Excess production of flatulence or gas from the back end
- Painful hiccups
- Some affected people also describe difficulty vomiting
The above symptoms seem to be made worse by the ingestion of carbonated drinks including beer or sparkling water and sometimes by strenuous exercise
How is the diagnosis of R-CPD made?
Patients have often seen multiple doctors complaining of these symptoms but as this is a newly described disorder it often goes undiagnosed or misdiagnosed as gastro-oesophageal reflux disease (GORD). The diagnosis is most often made by an ENT surgeon with expertise in recognising and treating the condition. The ENT will undertake a detailed history and clinical examination in order to confirm the diagnosis and exclude other possible structural causes. This may involve visualising the throat with a small flexible camera (laryngoscopy) which is passed via the nose using local anaesthesia.
What is the treatment for R-CPD?
Treatment is aimed at excluding more sinister pathology of the throat and oesophagus via visualisation along with a procedure to reduce the tightness of the muscle in order to help it relax when we need to burp. Treatment is usually performed under general anaesthetic where a flexible telescope is passed past the CP muscle then into the oesophagus and stomach where biopsies may be taken in some cases. Following this, a rigid endoscope is used to expose the CP muscle where it can be inspected and treated. A muscle relaxing medication** is generally injected into the CP muscle at this point although surgical division of the muscle with a laser is another option.
** – Note we are unable to name specific medications on our website here in Australia due to legal restrictions on medical advertising
Most people report an improvement in symptoms and restoration of the ability to burp within 3 weeks of the procedure although it may take a little longer for the medicine to take effect and smooth out. The most common side effect is a temporary difficulty in swallowing solids which usually lasts less than a few weeks
Please note – due to the high cost of the injectable medication – we are currently unable to offer this treatment in the Public Hospital system under medicare
A/Prof Novakovic and the team at Sydney Voice and Swallowing have expertise in the diagnosis and treatment of Retrograde Cricopharyngeal Dysfunction with information about the latest available therapies. Please make an appointment should you wish to discuss this condition further