Treating Retrograde Cricopharyngeal Dysfunction, AKA No-Burp Syndrome

February 16, 2023

Taylor Frazier standing in front of leavesFor as long as she can remember, Taylor Frazier, 26, had no ability to burp. Her mother remembers burping her as a baby, and at some point in her early teens, she started noticing bubbling and gurgling sounds in her chest.

“It was never an issue for me until I was 22 and started having really terrible abdominal pains after eating a substantial amount of any type of food. Sometimes the pains came at random,” Frazier says. “I had a lot of flatulence and abdominal bloating to the point that it looked like I was pregnant. On occasion I had chest pain and some pretty painful hiccups.”

Tests done by gastroenterologists, including an abdominal ultrasound, came back normal. Results of lab work for celiac disease and other disorders were negative.

One day, a video popped up randomly in Frazier’s TikTok feed; the girl who posted it was explaining that she had retrograde cricopharyngeal dysfunction (RCPD), also known as no-burp syndrome. “She had made a recording of the gurgling sounds in her chest that sounded just like mine,” she says. “She had other videos explaining RCPD, including one talking about her treatment with Botox® injections, and pointed to a forum on the Reddit website called No Burp. The forum had up-to-date information and a list of all the doctors known to treat RCPD. When I went to the Texas list, I found Dr. Tritter.”

Andrew Tritter, MD, is an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery and director of the Texas Voice Performance Institute™ at McGovern Medical School at UTHealth Houston. The institute provides comprehensive medical and surgical treatment of patients with voice and swallowing disorders.

“I was in Austin, and he was in Houston, and I was, like, this is the guy for me and I’m going to Houston,” Frazier says.

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Dr. Tritter treats two or three patients a month, almost all of whom have found him through his post on Reddit. “RCPD was first described in the literature three or four years ago and has come to light by people sharing their stories through social media,” he says. “Taylor is pretty typical of the patients I see. Almost all are in their 20s or 30s and have been unable to burp for most of their lives. Instead, they have gurgling in the chest. People are learning that a Botox injection to the cricopharyngeal sphincter muscle in the throat will cure the dysfunction for most people.”

After examining Frazier, he gave her the choice of an in-office Botox injection or the same treatment under general anesthesia. “For most patients, we can get a significant and consistent result in the office, but there is a slightly greater risk of Botox hitting the vocal cords, which will affect the voice,” he says. “For a reason we don’t understand yet, about 85 to 90 percent of patients experience long-lasting results after one application of Botox, unlike with its other uses.”

Frazier chose general anesthesia, and Dr. Tritter performed the procedure at Memorial Hermann-Texas Medical Center in August 2022. “When I woke up, I had a very prominent lump feeling in my throat and some difficulty swallowing anything except liquids or soft food. Dr. Tritter had warned me about that, and it was exactly as he described it,” she says. “My partner drove me back to Austin as soon as I was allowed to leave the hospital, and I went to work the next day. After two days, I started burping very loudly, like noises a very large man would make. As time went on, the lump got smaller and smaller, and about two weeks after the injection, I was able to return to a normal diet – with normal burps.”

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