For years, a man in his 30s dealt with a swollen belly, gurgling noises from his throat, and excessive gas. Tests came back inconclusive, and treatments failed. The answer finally came from his own search online, where he found a condition that matched his symptoms and proposed it to his ear, nose, and throat specialist.
The condition was retrograde cricopharyngeus dysfunction, or R-CPD, better known as no-burp syndrome. His case, published in April in Cureus by Ethan J. Jenkins and colleagues, stands out for two reasons. The patient also has Gilles de la Tourette syndrome, and he appears to have acquired R-CPD after a period of temporary difficulty swallowing, rather than living with it from childhood.
A Condition That Only Got Its Name in 2019
Burping depends on a brief relaxation of the cricopharyngeus, a muscle ring at the top of the esophagus. In R-CPD, that muscle fails to relax when air needs to escape upward. The trapped air produces bloating, gurgling, chest pressure, and flatulence.
An inability to belch was described as early as 1987, but the syndrome was not named and codified until 2019. That year, laryngologist Robert Bastian and physician assistant Melissa Smithson reported 51 patients treated with botulinum toxin injected into the cricopharyngeus. All 51 gained the ability to belch and relief of related symptoms, and in most the benefit appeared to outlast the drug's expected duration of action.
A 2020 follow-up from the same practice reviewed its first 200 treated patients and found that 99.5% gained the ability to burp. Many patients see several physicians and undergo procedures before diagnosis, Bastian's group has noted, because standard tests do not reveal the problem.
A 2024 review from Johns Hopkins notes that complaints often begin in adolescence and that many patients search for a diagnosis for years before obtaining treatment.
Why This Case Broke the Usual Pattern
Most people with R-CPD describe never having been able to burp. The Cureus patient's symptoms instead followed a period of transient dysphagia, or trouble swallowing, which is why the authors call his presentation atypical.
That makes him an outlier even among the patients reported so far. A 2026 review in the journal Toxins found that, across studies reporting when symptoms began, an average of about 55% of patients had a childhood history of the condition, and that among the rest, symptoms started mainly in adolescence and only rarely in adulthood. The same review cited a social media survey of 199 patients in which about 22% reported another affected family member.
His Tourette syndrome added another layer. Tourette syndrome involves involuntary movements and sounds known as tics, and the authors discuss the additional challenges that a concurrent Tourette diagnosis created in his care. The report does not establish any link between the two conditions, and one patient cannot show whether people with Tourette syndrome face a higher risk of R-CPD.
He was treated with a botulinum toxin injection into the cricopharyngeus muscle, which produced an initial positive benefit. The authors urge clinicians to consider R-CPD in patients with similar symptoms.
Social Media Is Driving Diagnoses
His path to a diagnosis is increasingly common. The Johns Hopkins review describes a recent rise in presentations fueled by patient-led social media discussion boards, often with patients diagnosing themselves before seeing a specialist.
Patients' experiences suggest why. An interview-based study of 199 adults with R-CPD, published in Neurogastroenterology & Motility, found that only half had discussed their symptoms with a primary care clinician, and 90% felt they did not receive adequate help. Participants also reported embarrassment, anxiety or depression, strain on relationships and disruption at work. Most described bloating, socially awkward gurgling, excessive flatulence and difficulty vomiting.
Botox Helps Many, but Questions Remain
Botulinum toxin injection is the first-line treatment, but there is no uniform dosing protocol, and relief does not last for everyone. Some patients need repeat injections, and a small number go on to surgery that partially cuts the muscle.
Side effects are possible. A 2026 report from the University of Southern California described a 41-year-old man who regained the ability to belch after two 40-unit injections a month apart but then developed trouble swallowing. Testing showed weakened muscle contraction in the throat and upper esophagus, which the authors described as transient, and a neurologic evaluation found no underlying neuromuscular disease.
The Cureus report describes only an initial benefit. A single case cannot show how long relief will last for this patient or whether his Tourette syndrome affects the outcome.
People who have never been able to burp, or who lose the ability and develop gurgling, bloating and heavy gas, may want to ask about R-CPD, particularly if treatments for other digestive conditions have not helped. An ear, nose and throat specialist familiar with swallowing disorders can evaluate the symptoms. Anyone with new swallowing trouble should see a clinician, since that symptom has many possible causes.
Key Questions Answered
What is no-burp syndrome?
Retrograde cricopharyngeus dysfunction, or R-CPD, occurs when a muscle at the top of the esophagus fails to relax to let air escape, causing bloating, gurgling, and flatulence.
What made this case unusual?
The man in his 30s also has Tourette syndrome, and his R-CPD followed a period of temporary swallowing difficulty rather than being lifelong.
How was he diagnosed?
After years of inconclusive tests, he found the condition online and suggested it to his ENT specialist.
How is R-CPD treated?
The first-line treatment is a botulinum toxin injection into the cricopharyngeus muscle. This patient had an initial positive response.
Does Tourette syndrome cause R-CPD?
No link has been established. A single case report cannot show whether the two conditions are related.
Published by Medicaldaily.com
