The Reddit subgroup r/noburp has more than 16,000 members and its tagline reads, “The struggle is real.” Until recently, the inability to burp or belch was not recognized as an official medical condition and people suffered in silence.

Well, not exactly silence. The condition often results in producing awkward gurgling noises as well as excess flatulence. It also causes painful bloating and chest and abdomen pressure.

The often painful and socially embarrassing condition is still largely undertreated, but that may change thanks to a new paper published by the American Academy of Otolaryngology Head and Neck Surgery. The paper describes a safe and remarkably effective in-office treatment using EMG-guided Botox injections.

The inability to burp or belch is associated with dysfunction of the cricopharyngeus muscle. This muscle is the prime mover of a sphincter in the throat that automatically relaxes/opens to allow swallowing. It also does the same to release trapped air in the form of a burp.

In some cases, the sphincter relaxes just fine to allow swallowing but not burping. This syndrome, called retrograde cricopharyngeus dysfunction (R-CPD), was first described in 2019 by Dr. Robert Bastian and Melissa Smithson of the Bastian Voice Institute in Illinois. An effective treatment, they found, is injecting botulinum toxin into the cricopharyngeus muscle under general anesthesia during an endoscopic esophagoscopy.

All 51 of the patients treated in this first study regained the ability to burp following the procedure. A minority of patients required repeat injections in six months or less but for most, the results lasted at least that long. Some had significantly longer, if not permanent, results.

“We cannot explain why many appear to maintain the ability to belch long after the botulinum toxin has worn off,” the authors wrote, suggesting some form of “re-training” of the muscle had occurred after injection.

There were few complications associated with this procedure, mostly associated with the anesthesia and esophagoscopy. These elements also add to the procedure’s expense.

The new study, for which Bastian was also senior author, takes aim at these issues. The authors describe a way this injection can now be done percutaneously using electromyography (EMG) guidance.

This technique can be performed in an office and “avoids the minor complications previously reported for injection via esophagoscopy under general anesthesia,” they write. This in-office procedure also costs about $1,190 less than a procedure with anesthesia and esophagoscopy.

A side effect seen in 28.9 percent of cases was a transient increase in “noisy breathing” and shortness of breath upon exertion. This was managed using breathing techniques, according to the authors.

All 18 of the patients treated in this in-office study regained the ability to burp by one week following the procedure. By six months, 80 percent of the patients could still burp and had completely resolved any associated symptoms.

Though small, this study could mark a big leap forward for patients with R-CPD. It reinforces the effectiveness of Botox injections while lowering the barrier to entry in getting the treatment.

While many still may not know about this treatment  — or even about the condition — the r/noburp subreddit is abuzz with talk of how Botox is changing lives.

“I’m now two years post-Botox treatment and still burping,” user u/zifod wrote. “It’s glorious.”



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