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R-CPD, or The Inability to Burp


Jun 10, 2020
My IBS issues started one night when I was 16, as I ate a PB&J sandwich. With one swallow, I suddenly felt like my throat was blocked. While I could breathe, swallowing felt painful and I noticed that I couldn't burp. When I tried to push air up from my stomach, it felt like a door in my chest prevented the air from traveling up the throat. When I got home that night, I noticed extreme bloating in my lower abdomen. I had never experienced bloating before.

Over the following few days, the bad bloating remained and I developed constipation. While the throat pain went away, I never regained the ability to burp. To this day, I've had chronic IBS. I told doctors about my inability to burp, but they never paid much attention to it and neither did I. They didn't know what caused my issues. I still have all the same gastrointestinal issues: chronic bloating, constipation, and the inability to burp normally. I can often let out a few "microburps" but never a real belch, as my friends do. I can feel when air wants to escape from my stomach, but it gets blocked somewhere in my chest and forced back down, where I believe it causes bloating. This trapped air may cause distention in my intestines, which then prevents normal peristalsis.

I had always overlooked my inability to burp, considering it a side detail about my IBS, rather than a fundamental cause of my IBS. Until yesterday, when I discovered r/noburp and Retrograde Cricopharyngeal Dysfunction (R-CPD). This is a surprisingly common disorder where the person is unable to burp, due to dysfunction with their esophagus muscles that prevents air from traveling back up and exiting through their mouth.

R-CPD symptoms overlap with IBS in many ways:
-Inability to burp (not a critical part of regular IBS)
-A gurgling sound from your chest (when trapped air tries to escape but can't)
-Constipation in some cases
-Hypersalivation (I don't have this, but many with R-CPD do)

Many people on r/noburp have successfully treated their R-CPD and permanently resolved their issues, regaining the ability to burp.

There seem to be two main routes of treatment:
1. Botox injection:
Dozens of throat and neck specialists offer a "surgery" where they inject botox into the patient's esophagus, which paralyzes it open for 6 months. During this time, the patient retrains their throat and chest muscles to burp. Apparently, 4/5 patients successfully cure their R-CPD using this treatment and they often describe it as "life-changing."
Example posts:
-2 Year Post-Throatox Update
-2 years post op
-14yr Old Daugter 6 wks Post Treatment
-4.5 months post-Botox and my life has changed

2. Postural and muscular retraining: Some people say that they've regained the ability to burp normally by retraining their posture and strengthening muscles, via physical therapy exercises like "dead hangs" and "shakers." This method seems a little less effective than the botox injection, but is obviously less invasive and has less potential for harmful side effects down the line.
Example posts:
-I think I cured myself! No botox
-I couldn’t burp until I was 22. Here’s some tips on how I learned to burp
-Started burping without procedure

A few questions...
-Do any of you match the criteria for R-CPD? (Personally, I think this may explain so many of my IBS symptoms, which may center around the fact that I can't burp.)
-What do you think about the botox treatment? What risks would you consider or expect? (Analyzing from a Peaty perspective, if it resolves a host of chronic digestive issues, it seems like a major positive because of all the inflammation and misery it would save. If effective, it also saves your intestines and esophagus from chronic damage resulting from bloat and reflux. However, injecting botox into your esophagus seems risky. There must be potential downstream negative effects that could come from this. I'm not really familiar enough with botox to know.)

Tim Lundeen

Feb 19, 2017
I wonder if this could be a result of mold toxicity? Peanut butter can have high aflatoxin content... Perhaps cholestyramine or other binders would resolve your r-cpd. Neil Nathan has a book that covers this,

Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities , and Chronic Environmental Illness​

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