Can't burp? You might have R-CPD
Quick summary
- If you've never been able to burp, it could be a condition called R-CPD.
- It may be more common than you'd think. In a big survey, about 1 in 70 adults had symptoms that fit it.
- There's a simple treatment, and it works for most people.
If you've never been able to burp, you're not alone. And no, you're not imagining it. There's a name for it, and there's a treatment.
It's called retrograde cricopharyngeus dysfunction, or R-CPD for short (we'll stick with R-CPD, we promise). You might also hear "no burp syndrome", "abelchia" or "inability to belch syndrome". Doctors first named it in 2019 (Bastian 2019 (opens in a new tab)).
What is R-CPD?
At the top of your food pipe (oesophagus) there's a little ring of muscle called the cricopharyngeus. It opens to let food and drink go down.
It should also open to let air back up. That's a burp. With R-CPD, it opens when you swallow, but not for air. So the air gets stuck (Oude Nijhuis 2022 (opens in a new tab)).
The signs
In a 2024 survey of 199 people with R-CPD (Chen 2024 (opens in a new tab)):
- 99% couldn't burp, usually for as long as they could remember.
- 98% had bloating, or pressure in the chest or upper tummy.
- 93% had gurgling or croaking noises in the throat or chest.
- 89% had lots of wind.
In a 2026 survey, 80% had painful hiccups too (Chen 2026 (opens in a new tab)).
Some people also find it hard to be sick. That was 55% in the 2024 survey (Chen 2024 (opens in a new tab)).
It usually starts in childhood. Across 17 studies, 55.5% said it began when they were young. And 28% had someone in the family with it (Lechien 2025 (opens in a new tab)).
How common is it?
More common than you'd think. It's now listed in Rome V, the official guide doctors use for gut problems like IBS (irritable bowel syndrome), as "inability to belch syndrome" (Rome Foundation (opens in a new tab)).
A 2026 survey of 28,771 adults in 15 countries found that 1.4% had symptoms that fit "inability to belch syndrome". That's about 1 in 70. (Prevalence, in the quote below, just means how many people have it.) The study says: “The prevalence of the new inability to belch syndrome diagnosis was 1.4%” (Sperber 2026, full text, Results section (opens in a new tab)). It was a symptom survey, not a test, so not everyone counted would have R-CPD.
Why it often gets missed
Lots of people are first told it's something else. In a 2025 study, that was 64%, most often reflux (stomach acid coming back up), anxiety or IBS. Only 7.5% got better on medicines like reflux tablets (Cosentino 2025 (opens in a new tab)).
Here's a funny thing: most people work it out for themselves. Across 17 studies, the patient spotted it first 78.9% of the time (Lechien 2025 (opens in a new tab)).
The good news: a simple treatment
The usual treatment is a small Botox injection into that ring of muscle. It helps the muscle relax, so air can get out. For many people, burping keeps working after the Botox wears off (Bastian 2019 (opens in a new tab)).
The results are really good news:
- Of the first 200 people treated, 99.5% could burp. And 79.9% still could six months after one injection (Hoesli 2020 (opens in a new tab)).
- In a UK group of 72 patients, every one could burp within four weeks (Karagama 2021 (opens in a new tab)).
- Across 13 studies and 699 patients, 91.45% got early relief (Yeo 2025 (opens in a new tab)).
You can have it awake in a clinic, sometimes called in-office (Wajsberg 2021 (opens in a new tab)). Or you can be asleep (a general anaesthetic, which is medicine that puts you to sleep for the procedure) and go home the same day, which is called a day case (Sulis Hospital Bath (opens in a new tab)).
The most common side effect is food feeling like it sticks for a while, for 31.1% (Lechien 2025 (opens in a new tab)). If burping fades, a second injection works for most people (Malhotra 2024 (opens in a new tab)).
What to do next
If this sounds like you, have a chat with your GP. Our guide to talking to your GP tells you exactly what to say.
Some signs aren't R-CPD and need checking soon. These include food or drink sticking when you swallow, or losing weight without trying (noburp.info (opens in a new tab)). If you have either, see your GP soon.
The same goes if you're being sick a lot, or bringing up blood (noburp.info (opens in a new tab)).
This is a free resource and not medical advice. Speak to your GP.
Sources
- Bastian and Smithson 2019, OTO Open (opens in a new tab)
- Oude Nijhuis et al. 2022, Neurogastroenterol Motil (opens in a new tab)
- Chen et al. 2024, Neurogastroenterol Motil (opens in a new tab)
- Chen et al. 2026 (opens in a new tab)
- Lechien et al. 2025, systematic review (opens in a new tab)
- Rome Foundation, Rome V criteria (opens in a new tab)
- Sperber et al. 2026, Gut (free full text, see Results) (opens in a new tab)
- Cosentino et al. 2025, Toxins (opens in a new tab)
- Hoesli et al. 2020, OTO Open (opens in a new tab)
- Karagama 2021, Eur Arch Otorhinolaryngol (opens in a new tab)
- Yeo et al. 2025, Laryngoscope (opens in a new tab)
- Malhotra et al. 2024, OTO Open (opens in a new tab)
- noburp.info: Is RCPD dangerous? (opens in a new tab)
- Wajsberg et al. 2021, OTO Open (opens in a new tab)
- Sulis Hospital Bath, ENT treatments (opens in a new tab)
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