Retrograde Cricopharyngeal Spasm (RCPS) — “No-Burp Syndrome”

What is it?

Retrograde cricopharyngeal spasm (RCPS), also known as R-CPD (Retrograde Cricopharyngeal Dysfunction) or “no-burp syndrome”, is a functional disorder in which the cricopharyngeus muscle (the upper oesophageal sphincter) fails to relax to allow swallowed air to travel back up and be released as a burp (eructation). The result is a lifelong inability to burp.

Symptoms

  1. Complete, lifelong inability to burp
  2. Bloating or pressure in the chest or abdomen, especially after eating or drinking fizzy drinks
  3. Audible gurgling noises from the throat or chest, often socially embarrassing
  4. Excessive flatulence / abdominal bloating
  5. A tight sensation in the throat or chest
  6. Chest discomfort that is sometimes mistaken for a cardiac or gastrointestinal problem

What causes it?

RCPS is thought to be a congenital dysfunction of the cricopharyngeus muscle, which normally relaxes briefly to allow air to pass upward (a burp). In RCPS the muscle stays contracted and does not allow this passage, so swallowed air becomes trapped in the upper digestive tract.

How is it diagnosed?

Diagnosis is largely based on history — a lifelong inability to burp together with the symptoms above is highly characteristic. Additional tests may include:

  1. A barium swallow (oesophagram) to exclude other causes
  2. High-resolution manometry, which can demonstrate failure of the upper oesophageal sphincter to relax in the retrograde direction
  3. A trial botulinum toxin injection into the cricopharyngeus muscle, which serves both a diagnostic and a therapeutic purpose

How is it treated?

The main treatment is a botulinum toxin (Botox) injection into the cricopharyngeus muscle, performed under endoscopic guidance (rigid endoscope usually under general anaesthetic as a short day-case procedure. The injection temporarily relaxes the muscle, allowing most patients to burp for the first time in their lives within a few days. In some patients the benefit is long-lasting, while others may need a repeat injection.

What will the ENT surgeon do?

The surgeon will take a detailed history and examine the throat with a flexible nasendoscope at your visit to exclude other causes of your symptoms. If the clinical picture is consistent with RCPS, a diagnostic/therapeutic botulinum toxin injection into the cricopharyngeus muscle will be discussed.