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Inability to burp or belch
- Inability to burp/belch
- What is this condition?
- Where to find treatment
Age of presentation: Most patients are in their 20s or 30s but any age can be affected. It is possible that some patients had the problem since childhood but it’s not been diagnosed.
There is no definitive cause for this condition but it might have be triggered by acid reflux. The function of the cricopharyngeal muscle is to prevent reflux of stomach contents into the throat. This muscle can therefore go into constant spasm hence preventing a simple burping from happening. The spasm might continue even when the acid reflux is treated.
The diagnosis of this condition is by simple history of the symptoms and clinical examination of the throat using an endoscope. A fibre optic flexible nasal endoscopy of the upper oesophagus may show a gas dilated oesophagus. Barium swallow Xray may show a cricopharyngeal muscle thickening and a dilated oesophagus. The endoscopy is simply to exclude other disorders in the throat like a lump or infection. Barium swallow, PH measurement and pressure manometer of the upper and lower oesophageal sphincters might be done to exclude a condition called achalasia, which is a narrowing of the gastro-oesophageal sphincter. The laboratory and clinical findings in inability-to-burp patient might all be normal hence these patients are sadly often told it’s all in their heads and shunned away by physicians. This condition is still not well described in the medical literature so information about it is scanty at best.
The treatment of this condition is by simple Botox injection into the cricopharyngeal muscle. This causes a temporary partial paralysis of this muscle and allows burping to begin again. Most patients will then learn the act of the burping before the the Botox wears off in about 3 months. Some patients might require a repeat of the Botox injection.
Some patients may experience a temporary excessive regurgitation and swallowing difficult but this will usually improve once the Botox wears off. So these symptoms should improve in a few weeks or months. Serious complications are rare.