Unlocking the Burp Reflex: A Review of Retrograde Cricopharyngeal Dysfunction
DOI:
https://doi.org/10.12775/QS.2026.50.68107Keywords
retrograde cricopharyngeal dysfunction, R-CPD, inability to belch, inability to burp, abelchiaAbstract
Introduction: The aim of this review is to synthesize current evidence on retrograde cricopharyngeal dysfunction in light of the rapidly expanding literature, summarizing contemporary knowledge on its pathophysiology, diagnosis, and management. Additionally, this study highlights challenges related to access to diagnostic and therapeutic services and underscores the significant impact of the condition on patients’ quality of life.
Materials and methods: A comprehensive review of the literature was conducted using the PubMed and Google Scholar databases using keywords: „retrograde cricopharyngeal dysfunction ”, „ R-CPD ”, „abelchia ”, „ inability to belch ”, „ inability to burp”, „upper esophageal sphincter”, „UES”. Citations were also screened in each article for additional sources.
Conclusions: Retrograde cricopharyngeal dysfunction (R-CPD) is an underrecognized condition with a characteristic symptom profile that significantly impairs quality of life and mental health. Its pathogenesis remains incompletely understood. High-resolution impedance manometry provides the most reliable diagnostic approach at this moment. Botulinum toxin injection into the cricopharyngeus muscle is currently the most effective treatment, offering rapid and often long-term symptom relief, with in-office or endoscopic approaches demonstrating comparable results. Further research is needed to refine diagnostics, optimize treatment protocols, and clarify long-term outcomes.
References
[1] Kahrilas, P. J., Dodds, W. J., & Hogan, W. J. (1987). Dysfunction of the belch reflex. A cause of incapacitating chest pain. Gastroenterology, 93(4), 818–822. https://doi.org/10.1016/0016-5085(87)90445-8
[2] Lechien, J. R., Hans, S., & Mailly, M. (2025). Validity and Reliability of the Burp Score. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 10.1002/ohn.70073. Advance online publication. https://doi.org/10.1002/ohn.70073
[3] Bastian, R. W., & Smithson, M. L. (2019). Inability to Belch and Associated Symptoms Due to Retrograde Cricopharyngeus Dysfunction: Diagnosis and Treatment. OTO open, 3(1), 2473974X19834553. https://doi.org/10.1177/2473974X19834553
[4] Karagama Y. (2021). Abelchia: inability to belch/burp-a new disorder? Retrograde cricopharyngeal dysfunction (RCPD). European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 278(12), 5087–5091. https://doi.org/10.1007/s00405-021-06790-w
[5] Hoesli, R. C., Wingo, M. L., & Bastian, R. W. (2020). The Long-term Efficacy of Botulinum Toxin Injection to Treat Retrograde Cricopharyngeus Dysfunction. OTO open, 4(2), 2473974X20938342. https://doi.org/10.1177/2473974X20938342
[6] Hoffman, M. R., Schiffer, B., Patel, R. A., & Smith, M. E. (2022). "I've never been able to burp": Preliminary description of retrograde cricopharyngeal dysfunction in children. International journal of pediatric otorhinolaryngology, 161, 111261. https://doi.org/10.1016/j.ijporl.2022.111261
[7] Oude Nijhuis, R. A. B., Snelleman, J. A., Oors, J. M., Kessing, B. F., Heuveling, D. A., Schuitenmaker, J. M., Ten Cate, L., Smout, A. J. P. M., & Bredenoord, A. J. (2022). The inability to belch syndrome: A study using concurrent high-resolution manometry and impedance monitoring. Neurogastroenterology and motility, 34(5), e14250. https://doi.org/10.1111/nmo.14250
[8] Dorfman, L., El-Chammas, K., Mansi, S., Graham, K., & Kaul, A. (2024). Pediatric retrograde cricopharyngeal dysfunction diagnosed by high-resolution impedance manometry. Journal of pediatric gastroenterology and nutrition, 78(5), 1098–1107. https://doi.org/10.1002/jpn3.12193
[9] Yousef, A., Krause, A., Yadlapati, R., Sharma, P., & Weissbrod, P. A. (2024). Upper Esophageal Sphincter and Esophageal Motility Pathology on Manometry in Retrograde Cricopharyngeal Dysfunction. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 171(2), 478–485. https://doi.org/10.1002/ohn.735
[10] Raymenants, K., Vulsteke, F., Vanuytsel, T., Rommel, N., Baert, F., Delsupehe, K., Bohyn, A., Tack, J., & Arts, J. (2026). Diagnosis of Retrograde Cricopharyngeus Dysfunction Using High Resolution Impedance Manometry and Comparison With Control Subjects. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 24(1), 81–91.e4. https://doi.org/10.1016/j.cgh.2024.12.014
[11] Lechien J. R. (2025). Beyond the Inability to Burp: A Comprehensive Pathophysiological Theory of Retrograde Cricopharyngeal Dysfunction. Ear, nose, & throat journal, 1455613251353647. Advance online publication. https://doi.org/10.1177/01455613251353647
[12] Chen JN, Evans J, Fakhreddine AB, Stroever S, Islam E, Islam S. Retrograde cricopharyngeus dysfunction: How does the inability to burp affect daily life? Neurogastroenterology & Motility. 2024; 36:e14721. https://doi.org/10.1111/nmo.14721
[13] Waterman, D. C., & Castell, D. O. (1989). Chest pain and inability to belch. Gastroenterology, 96(1), 274–275. https://doi.org/10.1016/0016-5085(89)90822-6
[14] Sato, H., Ikarashi, S., & Terai, S. (2019). A Rare Case Involving the Inability to Belch. Internal medicine (Tokyo, Japan), 58(7), 929–931. https://doi.org/10.2169/internalmedicine.1908-18
[15] Xie, M., Wen, H., & Dou, Z. (2022). Case report: A case of novel treatment for retrograde cricopharyngeal dysfunction. Frontiers in neurology, 13, 1005655. https://doi.org/10.3389/fneur.2022.1005655
[16] A. Keltz, K. E. Simmons, and M. Z. Lerner, “ Behavioral Eructation Retraining Protocol (BERP): A Novel Adjunct Behavioral Therapy for R-CPD ,” The Laryngoscope 135, no. 12 (2025): 4800–4807, https://doi.org/10.1002/lary.32427.
[17] Bastian, R. W., & Hoesli, R. C. (2020). Partial Cricopharyngeal Myotomy for Treatment of Retrograde Cricopharyngeal Dysfunction. OTO open, 4(2), 2473974X20917644. https://doi.org/10.1177/2473974X20917644
[18] Dorfman, L., Mansi, S., El-Chammas, K., Liu, C., & Kaul, A. (2024). Interpretation of Impedance Data on High-resolution Impedance Manometry Studies-A Worldwide Survey. Journal of neurogastroenterology and motility, 30(1), 46–53. https://doi.org/10.5056/jnm23057
[19] Runggaldier, D., Colotto-Vith, U., Pohl, D., & Bohlender, J. E. (2024). Hilfe, ich kann nicht rülpsen: Falldarstellung und Kurzübersicht zur retrograden krikopharyngealen Dysfunktion [Help, I can't burp! A brief overview and case discussion of retrograde cricopharyngeal dysfunction]. HNO, 72(2), 72–75. https://doi.org/10.1007/s00106-023-01383-x
[20] Larsen, D. G., Aalling, M., Udholm, N., & O'Leary, P. (2025). Retrograde cricopharyngeal dysfunction management with botulinum toxin A. Danish medical journal, 72(8), A03250166. https://doi.org/10.61409/A03250166
[21] Pavesi, L., Balzano, C., Mauramati, S., Giudice, C., Fresia, M., Todisco, M., Alfonsi, E., & Cosentino, G. (2023). Retrograde Cricopharyngeus Dysfunction effectively treated with low dose botulinum toxin. A case report from Italy. Frontiers in neurology, 14, 1238304. https://doi.org/10.3389/fneur.2023.1238304
[22] Wajsberg, B., Hoesli, R. C., Wingo, M. L., & Bastian, R. W. (2021). Efficacy and Safety of Electromyography-Guided Injection of Botulinum Toxin to Treat Retrograde Cricopharyngeus Dysfunction. OTO open, 5(1), 2473974X21989587. https://doi.org/10.1177/2473974X21989587
[23] Yeo, W. X., Tan, B. K. J., Gao, E. Y., Yeap, S. Y. Y., & Leong, Z. H. (2025). Botulinum Toxin Injection in Retrograde Cricopharyngeal Dysfunction: A Meta-Analysis. The Laryngoscope, 135(11), 4030–4041. https://doi.org/10.1002/lary.32296
[24] Tritter, A., Simko, A., & Asi, K. (2025). How I Do It: The Transtracheal Approach for Awake Cricopharyngeal Botulinum Toxin Injection. The Laryngoscope, 10.1002/lary.70254. Advance online publication. https://doi.org/10.1002/lary.70254
[25] Wei, P., Xu, Y., Zhang, Z., Zhang, S., & Lv, Z. (2019). Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia: A case report. Medicine, 98(13), e14988. https://doi.org/10.1097/MD.0000000000014988
[26]Lechien, J. R., Hans, S., & Mailly, M. (2025). In-Office Transnasal Botulinum Toxin Injections for Retrograde Cricopharyngeal Dysfunction. The Laryngoscope, 135(11), 4144–4146. https://doi.org/10.1002/lary.32336
[27] Leming, A. B., Vance, D. G., Tritter, A. G., & Yang, Z. M. (2025). Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) for the Operative Management of Retrograde Cricopharyngeus Dysfunction. OTO open, 9(4), e70173. https://doi.org/10.1002/oto2.70173
[28] Kutler, R. B., Siddiqui, S. H., Tipton, C. B., Born, H. L., & Pitman, M. J. (2025). Office v OR Injection for Retrograde Cricopharyngeal Dysfunction: Evidence-Based Treatment Algorithm. The Laryngoscope, 135(11), 4147–4154. https://doi.org/10.1002/lary.32322
[29] Miller, M.E., Lina, I., O'Dell, K. and Akst, L.M. (2024), Experiences of Patients Living with Retrograde Cricopharyngeal Dysfunction. The Laryngoscope, 134: 2136-2143. https://doi.org/10.1002/lary.31157
[30] Wright, A., Hunter, N., Jin, V., & Tritter, A. (2025). Analysis of Content Related to Retrograde Cricopharyngeal Dysfunction on TikTok: Opportunities for Patient Education and Advocacy. The Annals of otology, rhinology, and laryngology, 134(11), 814–818. https://doi.org/10.1177/00034894251342111
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Chludek, Karol Dańda, Barbara Chobot, Marta Wachowska, Julia Chmielowiec, Zuzanna Czyżewicz, Kinga Dworak, Natalia Trędota, Dominika Posid, Michał Lewczuk
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 14
Number of citations: 0
