Retrograde Cricopharyngeal Dysfunction: A Multidisciplinary Approach to Diagnosis and Management
Sydney Pomenti, Alexa Choy, Hayley Born, Michael PitmanBackground:
Retrograde cricopharyngeus dysfunction (RCPD), also known as “no-burp syndrome,” is an increasingly recognized disorder characterized by failure of upper esophageal sphincter (UES) relaxation during retrograde gas venting despite preserved anterograde swallowing function. The critical diagnostic symptom of RCPD is the inability to belch. Patients can experience severe bloating, chest pressure, gurgling noises, and social distress, often for years prior to diagnosis.
Methods:
We performed a narrative review of the emerging literature on RCPD, focusing on its pathophysiology, clinical presentation, diagnostic evaluation, esophageal physiologic testing, and therapeutic management. Relevant studies from gastroenterology and otolaryngology were reviewed, including investigations utilizing high-resolution impedance manometry (HRIM), fluoroscopic assessment, and outcomes following cricopharyngeal interventions.
Results:
The hallmark symptom of RCPD is a longstanding inability to belch, which distinguishes the disorder from other causes of bloating and gas retention, including aerophagia and disorders of gut-brain interaction. Emerging physiologic evidence supports RCPD as a disorder of impaired retrograde UES relaxation during gas reflux events. High-resolution impedance manometry with carbonated belch provocation may demonstrate absent or impaired UES relaxation, paradoxical UES contraction, air entrapment, and secondary peristalsis. Botulinum toxin injection into the cricopharyngeus muscle remains the primary treatment, providing both diagnostic confirmation and symptom improvement in most patients, with durable restoration of belching reported in many cases. Additional therapeutic approaches include electromyography-guided injection techniques and adjunct behavioral therapies.
Conclusions:
R-CPD is a distinct, underrecognized, and treatable disorder at the intersection of gastroenterology and otolaryngology. Although many patients can be diagnosed clinically based on characteristic symptoms, physiologic testing can provide objective confirmation and improve diagnostic confidence. Increased awareness, multidisciplinary collaboration, and continued investigation into diagnostic and therapeutic strategies are needed to improve outcomes for affected patients.