Some individuals do not have the ability to belch or burp. This is associated with symptoms of gurgling throat noises, chest and abdominal discomfort and fullness and even excessive flatulence. This group of symptoms has recently been identified and titled “retrograde cricopharyngeal dysfunction”.
Retrograde cricopharyngeal dysfunction occurs when a muscle at the bottom of the throat, the cricopharyngeus muscle, is overly tight. This muscle circles around the bottom of the throat. When someone belches or burps, air is forced out of the stomach, through the esophagus and eventually must pass through the cricopharyngeus muscle. When this muscle is too tight, air cannot escape and belch does not occur. This is especially symptomatic after an affected person drinks a carbonated beverage.
Treatment of this is placement of Botox into the cricopharyngeus muscle. Botox is a medication that relaxes muscles. In the operating room with a patient asleep a small tube is placed in the mouth to identify the cricopharyngeus muscle. Botox is injected and patients experience benefit within 2-3 days. Initially swallowing can be a little challenging, but with time the ability to belch returns. The patient typically only requires one Botox injection, but occasionally a second one is needed 6-9 months later.