ReviewTranslational gastroenterology and hepatology2026
Retrograde cricopharyngeus dysfunction (R-CPD), also known as inability to belch syndrome-a narrative review.
Review in Translational gastroenterology and hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Objective: Retrograde cricopharyngeus dysfunction (R-CPD), also known as 'inability to belch syndrome', is an under-recognized disorder wherein the upper esophageal sphincter (UES) fails to open following gaseous reflux. First described in 1987, R-CPD was rediscovered in 2019 along with the first effective treatment, endoscopic botulinum toxin (Botox) injection into the cricopharyngeus (CP). Since then, there has been an explosion of literature on R-CPD. The objectives of this review were to discuss the physiology of belching and R-CPD along with the epidemiology, diagnostic criteria, and clinical experience in managing R-CPD. Methods: Relevant publications with an abstract in English were identified using the PubMed, Scopus, and Cochrane databases (time frame: 1987-November 15, 2025). Key Content and Findings: Along with an inability to belch, R-CPD is associated with an array of symptoms including gurgling noises in the chest, bloating, flatulence, and chest pain that can compromise a patient's quality of life. The ultimate cause of R-CPD is dysfunction of the vago-vagal reflex mediating UES opening in response to gaseous distention of the esophagus. This can be demonstrated with high-resolution manometry (HRM) by provoking the need to belch with ingestion of a carbonated beverage. However, most R-CPD cases come to light via internet forums such as "#noburpsyndrome" on TikTok and to date most cases (estimated in the thousands) have been treated without physiological confirmation. The reported success rate of Botox treatment is about 90% with only transient dysphagia as a side effect and with many treated patients having a response lasting beyond the expected 4-month duration of action of Botox. This suggests that many R-CPD cases may be amenable to behavioral/biofeedback therapy as has also been claimed on internet forums and in a published case report. Conclusions: R-CPD is characterized by an inability to belch and a characteristic array of associated symptoms caused by physiological dysfunction of the UES. R-CPD is demonstrable by an HRM study with carbonated beverage provocation and treatable with Botox injection to the CP. Future studies are needed to clarify whether R-CPD exists in a mild-to-severe spectrum and what proportion of R-CPD cases are amenable to behavioral therapy.
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