Retrograde cricopharyngeal dysfunction ​(R-CPD) is a condition characterised by an inability to burp or belch. It occurs when the cricopharyngeus muscle, located at the top of the oesophagus (food pipe), fails to relax; stopping air underneath from escaping.

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Also known as:

• No-burp syndrome

• Retrograde cricopharyngeus dysfunction

• Retrograde cricopharyngeus muscle dysfunction

• Inability to belch syndrome

• Abelchia

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People with R-CPD commonly experience:

• Inability to burp or belch

• Gurgling noises in the throat or chest

• Abdominal bloating, pressure and discomfort, particularly as the day goes on

• Excessive flatulence

• Discomfort following meals or carbonated drinks

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These symptoms can have a significant impact on comfort, social participation and quality of life.

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Diagnosis and medical management

R-CPD requires medical assessment and diagnosis, typically by an Ear, Nose and Throat (ENT) specialist.

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The most established treatment involves injecting botulinum toxin (Botox) into the cricopharyngeus muscle. This temporarily relaxes the muscle, allowing air to escape. Many people subsequently retain the ability to burp after the effects of Botox have worn off.

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Speech pathology and behavioural retraining​

Behavioural retraining is an emerging approach to managing R-CPD. Recent research has described the Behavioural Eructation Retraining Protocol (BERP), a speech pathology intervention involving education, targeted movements and positioning strategies designed to facilitate burping.

Early findings are encouraging, particularly for people who have previously received Botox but continue to experience difficulty burping or a recurrence of symptoms.

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There is also growing interest in the possibility of learning to burp through behavioural therapy without first receiving Botox. However, this possibility remains largely unexplored, and there is currently insufficient evidence to establish speech pathology alone as an effective alternative to Botox. 

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R-CPD retraining at Swallow Science Melbourne​

Swallow Science Melbourne offers individualised speech pathology consultations and behavioural retraining for people who have undergone medical assessment for R-CPD.

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Our services may be suitable for people who:

• have experienced an incomplete response to Botox.

• have a recurrence of symptoms following Botox treatment.

• have received a medical diagnosis of R-CPD but are awaiting Botox treatment (e.g. on a waitlist). 

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For people awaiting Botox, speech pathology may provide an opportunity for education, preparation and consideration of behavioural strategies while medical treatment is being arranged. The potential benefits of retraining before Botox remain uncertain and are discussed as part of individual clinical decision-making.

 

Our approach is guided by emerging research, including BERP, and emphasises realistic expectations and collaboration with medical specialists.

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Speech pathology does not replace medical assessment or established treatment for R-CPD. People who have not yet received a diagnosis are encouraged to seek ENT assessment.

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Interested in exploring your options? 

Contact Swallow Science Melbourne to discuss whether an R-CPD speech pathology consultation may be suitable for you.

 

 

 

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Further reading

Keltz, A., Simmons, K. E., & Lerner, M. Z. (2025). Behavioral eructation retraining protocol (BERP): A novel adjunct behavioral therapy for R-CPD. The Laryngoscope, 135(12), 4800–4807. https://doi.org/10.1002/lary.32427
 

Lehmann, A., & Kahrilas, P. J. (2026). Retrograde cricopharyngeus dysfunction (R-CPD), also known as inability to belch syndrome: A narrative review. Translational Gastroenterology and Hepatology, 11, Article 74. https://doi.org/10.21037/tgh-2025-158