Retrograde cricopharyngeus dysfunction (R-CPD) is a medical condition first identified by Dr Robert Bastian of the Bastian Voice Institute in which people are unable to burp.^[1] Some with the condition are also unable to vomit, or can only do so with great difficulty. It is a lifelong problem that is usually first noted in adolescence, but has also been reported as early as infancy. Most people with this condition also complain of frequent bloating, "gurgling noises" from the throat, frequent flatulence and poor tolerance to carbonated beverages. Many sufferers experience noticeable abdominal distension, with men and women alike saying they look "six months pregnant" by the end of the day. As air is released through the night, the abdomen will assume a more normal appearance by morning.

The cricopharyngeus muscle is also described as the upper esophageal sphincter. It is a circular muscle at the base of the throat, behind the larynx. The muscle is closed (actively contracting) at all times and opens for swallowing or to allow relief of pressure in the esophagus via burping or vomiting. In R-CPD, the swallowing function of the muscle is normal but the response to pressure in the esophagus is absent.

Diagnosis of R-CPD is achieved primarily through a positive match of telltale symptoms. Many patients finally get an accurate diagnosis of R-CPD after having been subjected to years of testing for, and unsuccessful treatment of, gastronomical disorders like GERD, aerophagia, gallbladder dysfunction, and IBS.

The initial treatment of R-CPD is injection of botox into the cricopharyngeus muscle. botox will temporarily weaken or paralyze the muscle. The direct effects of botox last for three months on average. For most patients with R-CPD, injection of botox into the cricopharyngeus muscle will reverse the symptoms, and for many, the effect will last beyond the first three months. 30% of patients describe some swallowing difficulty after the injection that usually resolves after the first 3-4 weeks.

The first treatment is usually performed under general anesthesia. The procedure lasts 15-20 minutes and results in a mild sore throat. The effect of botox is delayed for three days on average and most patients with successful results report the ability to burp by the fifth day after the procedure. Subsequent injections can be considered and administered with local anesthesia.^[2]

An alternative if the injection is unsuccessful is to undergo partial cricopharyngeal myotomy.^[3]