Dysfunction of the Burp Reflex (DBR) 2: The Cricopharyngeus Muscle

Apologies to all who have been awaiting more posts about the dysfunction of the burp (or belch) reflex (DBR). The sad truth is that I didn’t have anything new to write about! However, thanks to a couple of comments left in the previous post about this topic, there is a bit more I can add.

I had previously mentioned that the injection of botulinum toxin, commonly known under the brand name Botox, into the upper oesophageal sphincter was a new therapy to treat DBR (it has already been used for decades to treat other problems). Since my previous DBR post, a reader commented that her daughter had had the procedure done at the Bastian Voice Institute in Illinois, and that it appeared to have been successful. With other readers going for the same procedure at the institute and with the reassurance that they have had a 100% success rate out of 21 patients so far, it prompted me to try and find out more about this procedure.

Don't worry, it's not that scary! The injection is usually given under general anaesthetic.
Don’t worry, it’s not that scary! The injection is usually given under general anaesthetic.

Botulinum toxin is a powerful neurotoxin produced by Clostridium botulinum bacteria, and one of the most poisonous biological substances known to science. It causes muscle paralysis, which is why it is used for its most well-known application – smoothing facial wrinkles. It does have non-cosmetic uses, including the treatments of overactive bladder, chronic migraine and muscle spasticity and spasms in conditions such as cerebral palsy and multiple sclerosis. Of more interest to DBR sufferers, it is also used to treat upper  oesophageal sphincter dysfunction. It has more conventionally been used to treat difficulty swallowing, or dysphagia, and it is only more recently that the Bastian Voice Institute has used it for DBR.

I was very pleased to find during my Googling that the Bastian Voice Institute has an informative and very sympathetic page about DBR on their brilliantly named “Laryngopedia”. It outlines that a muscle around the upper oesophageal sphincter called the cricopharyngeal muscle is likely responsible for the problem. The cricopharyngeal muscle is normally tense and contracted in order to keep the sphincter closed. Upon swallowing and belching, it relaxes to allow food in or air out. If it is overly tense and doesn’t open in the downward direction the patient will have problems swallowing (antegrade dysfunction). If it doesn’t open to allow movement upwards, then belching can’t occur (retrograde dysfunction). So according to them, what non-burpers are suffering from is retrograde-only cricopharyngeus dysfunction. A bit of a mouthful, but at least it has a more serious name than “can’t burp”!

Cricopharyngeal muscle Bastian Voice
The highlighted area shows the cricopharyngeal muscle. Taken from the Laryngopedia, Bastian Medical Media.

There is a much more well-known condition called cricopharyngeal spasm, where the muscle becomes very contracted and causes a lump in the throat feeling. Some sufferers say it is like having phlegm in the throat that won’t clear. It’s often caused by stress and anxiety, and in some cases having a diagnosis and knowing it’s not harmful is reassuring enough to make it go away. Could this point to stress-relief and relaxation techniques possibly being helpful in DBR? I don’t think I’ve been able to burp when I’ve been relaxed, but it’s a possible avenue to explore. I did find myself feeling a bit annoyed upon discovering that despite cricopharyngeal spasm being well-documented, people who can’t burp are being so readily dismissed.

You can read more about the cricopharyngeal muscle and see some lovely photos of it in the Bastian Voice Institute’s Laryngopedia. From what the Institute has reported, every DBR patient who has had the botulinum toxin into the muscle has been able to belch afterwards and effectively been cured. This seems to indicate that in DBR cases where there is no known cause (such as oesophageal cancer), an overly tense cricopharyngeal muscle is the problem. They even mention that although they offer repeat injections if the DBR returns, no patients have yet needed one – the injection seems to reset the faulty muscle.

So far it seems that the Bastian Voice Institute is the only place that offers this procedure. If anybody has come across it elsewhere, please let me know and I’ll post an update. If you would like more information on the Bastian Voice Institute or contact details please go to their website. Sadly for those outside of the US, it may be much more difficult to find a provider. Hopefully as more patients go for the treatment and awareness is increased, this will change.

Just to clarify, I’m not affiliated with the Bastian Voice Institute in any way.

55 thoughts on “Dysfunction of the Burp Reflex (DBR) 2: The Cricopharyngeus Muscle

  1. THANK YOU! Just made my appointment with Dr. Bastian. I was literally in tears when I read the link about laryngopedia. It completely explains exactly what happens and gives hope for relief after a lifetime of suffering with this disorder. I can’t wait! And I can’t thank you enough for this blog. Flying to Chicago from Florida in April. Will keep you updated on the progress. BTW, Dr. Bastian is in network for our insurance, so we will have a minimal expense of flight, hotel, deductibles, and the cost of the botox itself. Small sacrifice if it is successful.

    1. That’s great to hear, JK! I’m really happy that you’ve found the blog helpful, and hope that you’ll finally get some relief from the condition. Good luck with your appointment and procedure!

      1. How do you find out the info on costs of the procedure? Do I just need to call Dr. Bastian’s office and tell them I need to see him for treatment of DBR? Will they give me the infor to call my insurance to find out all the costs that will be related to this? I’m in Texas so I’d have to fly and get a hotel as well. Thank you for any info!

      2. Thank you for this blog. I have struggled with this all my life and finally am hopeful about getting some relief. I will be following your posts for more information.

    2. Hey, were you able to have this procedure? How did it go? I would love to hear from you. I am interested in doing it myself.

      1. Hi Chanel, Yes, I had the procedure done on April 12. It has completely relieved the chest pressure and allowed me to burp — Since botox wears off, I’m still in the wait and see period. Hoping that my burp reflexes have been permanently reset and there will be no more issues in the future.
        Dr. Bastian and the day center surgery were wonderful. I have complete confidence in recommending the evaluation and procedure by Dr. Bastian. Please let me know if you have it and how you’re doing.

  2. Oh my God!!!! Thank you so much for this! I thought I was the only one who suffered from this. My family and friends think its funny. My doctor thinks I’m crazy. Recently the bloating has gotten so bad that it is now causing other medical problems. My stomach fills up so much with air that I can’t eat and yet I’ll have severe hunger pains. I’m miserable. I find that I’m involuntarily yawning excessively to try to release the excess air but only little gurgles come out. I have been unable to burp my whole life. I was also a very colicky baby. I have to be very careful about which foods and drinks I eat and I can forget about having anything carbonated! I am seeing a GI specialist this coming Wednesday so that is what promoted me to do some research on the internet. I had no idea that other people have had this same condition!!! Now at least I feel like I can go to the appointment with some information of my own. I hope they can give me some answers!

    1. I’m glad you found the blog helpful, Karen! I hope you can get some proper answers at your GI appointment. All the best.

  3. Last week I flew to Chicago from Florida to have the botox injections with Dr. Bastian at Bastian Voice Institute. It’s been exactly 9 days since my procedure and I can say emphatically that it was 100% successful. Dr. Bastian is amazing and the surgery center was great. I never had any doubts about having it done because my discomfort from bloating in my chest, pain, and having to gag myself to get relief was so horrible that I would have tried anything. I have total relief from pressure building in my chest, I’ve been able to go out to eat and socialize without fear of ‘getting sick’, I’ve been able to drink beer. I don’t know if the botox will permanently ‘reset’ my burp reflex. Time will tell. Discomfort from the procedure was primarily a sore throat at night. Everything happened exactly as Dr. Bastian described in the “what to expect” talk. I am able to voluntarily burp – but my burps don’t sound like normal burps. Who cares? It’s a joy to be able to relieve the pressure. If a time comes when I need to have it done again, I’ll book a flight back to Dr. Bastian. Any questions? I’ll be happy to share.

    1. How long did you have to stay in Illinois for the procedure? I’ll also be flying in from out of state and am not sure how long to book my trip. My husband wants to visit Wrigley while we’re there so how did you feel the days following the procedure? Thanks for any info!

      1. Hi Heather, just saw your questions. Sorry for the delay. On vacation with spotty wifi. I flew up on Monday. Had an easy consult and swallow test in office on Tuesday. Had the procedure on Wednesday, flew home on Thursday. Sore throats primarily at night but nothing really uncomfortable. After the procedure I slept for several hours but afterwards I felt perfectly fine. Swallowing food wasn’t too difficult, eat small amounts for the first few days and follow with sips of water. I had 3 baby burps in succession on the flight home and was so thrilled I wanted to do a happy dance in the aisle. I felt fine after the procedure- you should be able to do anything you want but not drive, drink alcohol or sign legal docs the day of your procedure. Can’t wait to talk to you about it,

        1. Hi JK, I was so happy to find this site and read your message. I am 58 and thought I was too old to worry about it anymore. I have had this all my life and just “gotten used to it”. Most of the posts I had been reading were from younger people! I am thinking about contacting Dr. Bastian. I am curious to hear if you are still getting relief?

          1. Hi Lisa,
            The answer to your question is “yes” and “no”. Sorry to be ambiguous. For about the first 4 months after the procedure, I was burping easily and had learned to burp intentionally. It was such a unique experience and I absolutely loved it! Over the past couple of months I have had a decrease in the ability to burp, flatulence is up — and burping requires more effort. I’ve found that if I raise my chin as high as it will go, and just gently push my adam’s apple either right or left, it opens the esophagus and I have a little burp. Not exactly the complete cure I had hoped for. Obviously the botox is wearing off. There is another procedure – a laser myotomy, that, according to Dr. Bastian, is a complete cure. I’m not ready to go that route. Fortunately, the excruciating pain and bloating has not reoccurred yet. If it does, I may opt to have the procedure again. I am very happy to have had the procedure. For one, it was a positive diagnosis for my upper esophageal dysfunction — and secondly, it gave me several months of freedom from what was almost daily misery. If you are used to it, and it’s not something that causes you daily pain and doesn’t interfere with your social or work life — you might not want to go through the expense and time to have the botox. For me, it worked, and I’m happy for that — – even though it seems to be wearing off. Good luck to you in your decision making. Also, Dr. Bastian is terrific. I had complete confidence in him and the surgery center.

          2. Thanks for your reply, I don’t have the chest pain that other have but have daily bloating and daily gag up gas sessions. I would love to get some relief and not have the “growling” all the time as well as the constant bloating. I think I will contact Dr. Bastian. Please keep me informed about your progress. Good luck!

          3. Oh, meant to say — I’ve only felt the need to gag myself twice in the past month – – – and the gurgles are very infrequent and mild since the procedure. Good luck – feel free to contact me any time. My number is 386-503-8069. Be sure to leave a message and tell me it’s about the botox procedure — I don’t answer numbers I don’t recognize. Good luck to you!

        1. JK,
          Did you also have the frog like sounds after eating? My daughter suffers from the loud frog like sounds and inability to burp but, does not have bloating or pain.
          Thanks, bb

          1. Yes. I called them “growls”. But yes. I think it came from gurgling gases in my esophagus that couldn’t get out. i didn’t always have pain and bloating. That started about 10-15 years ago. I’m 63 now.

          2. Hi, Did your daughter have the procedure? I’ve been thinking of her and hoping all went well.

    2. I’m so happy to hear that the procedure worked for you, JK! It’s great that you can finally get some relief from the horrible symptoms.

  4. Wow! I’ve suffered with non burping (very rarely) all my life and people laugh when I say I don’t burp and immediately assume I mean I hold back my burps. If I explain that it just doesn’t happen even if I try that look cynical. I’m so glad I have some information on this now. I’m happy to help with any research too.

  5. For those who have had the procedure done by Dr. Bastian, did you still have gurgling/croaking in the days following the procedure?

  6. This is honestly the best news I’ve heard in my entire life. I’ve had this issue for as long as I can remember and also suffer from anxiety attacks when it gets really bad and I feel like I can’t breathe. Definitely going to contact Dr. Bastian asap. I feel like this will change my life..thank you so much!!

    1. Glad this post was helpful, Britni! All the best with your appointment, and I hope that that will be the end of your DBR woes!

  7. Hi everone i love reading your messages. Especially the success storys ! I live in the uk and had the same problem all my life. I had doctor after doctor laugh at me and think its funny or that i am wasting their time. But i have find hopfully a doctor in the uk that will do the botox opp. He is in Manchester royal infirmary. Along way from me but at this point if he was on the moon i would go. I will find his name and let you guys know.

    1. Hi Mark, thanks for your comment! Thanks so much for telling us about a UK doctor who might perform the Botox injection for this – it gives all of the UK sufferers a bit more hope that something can be done about it a bit closer to home, and also that there’s actually a doctor in this country taking the condition seriously. Manchester is pretty far from me too, but it’s a heck of a lot closer than Illinois. If you get the procedure done, please could you keep us updated about how it goes?

    2. Hi Mark – have you been to see Dr Karagama as I have been looking into this as I have never been able to burp? I have been trying to find a Consultant in the South East but it seems Dr Karagama is the only UK Consultant? Do you know of any other surgeons in the UK who are experienced at this procedure?

      1. Hi hope your good. I went up to Manchester on Monday a saw him. He is a nice guy very helpful :). They did some tests cam and air test and he thinks I would benefit from the op. I will keep you updated :).

        1. Hi Mark. I’m just wondering what the outcome of your appointment in Manchester was. I saw this is a private hospital. Do you have any idea if this is offered on the NHS and if not what the cost of private treatment is?

          Also does anyone know what the technical name of the procedure is to enquire about?

          Many thanks

          1. Hi it went well. Had the tests done and just waiting for a date for the opp. I am using the NHS not private. I will find out what it is called for you .

        2. I look forward to hearing all about how this goes! I am being passed around different departments at my local hospital as nobody has heard of this issue before. I have now emailed your Dr Karagama and hope to get some advice about how to approach getting treatment. Fingers crossed practitioners become more aware of this condition and we can all get treated!

          1. Hi that’s great I hope he can help you ! Sadly my opp has been put off because of the NHS problems. This sucks big time as i was hoping to have it all sorted soon. But I understand and as long as get it done I will be happy. Will keep you updated.

  8. Hi Everyone –
    Sorry to report that I can no longer burp after having the Botox injection by Dr. Bastian in Chicago. The Botox seems to have worn off completely, and I am back to gagging myself to relieve the gas in my esophagus. I wish I had had a permanent cure – – – – as so many others seem to have. I’m not disappointed about having had the procedure. It worked for about 4 months.

    1. I’m in the same boat. I can no longer burp as the Botox wore off at about 3 months. I don’t regret getting the procedure done and enjoyed my results while they lasted.

    2. Sorry to hear about it wearing off JK. Sadly the search for a permanent cure goes on. Thanks for keeping us all updated on your whole journey throughout this procedure.

  9. I suffer from DBR, and I also have trouble swallowing. The actual act of swallowing is fine, but I always get things stuck in my throat and I have to take big gulps to force them down. I have dealt with this my whole life, and though it was annoying, I never really cared to seek treatment. Until now. My grandfather passed away at the beginning of September. He had heart surgery and had been diagnosed with COPD all within a month a little over a year ago. He went from taking no medications to taking a bunch of different meds almost overnight. You can bet that at least a few of them had gas as a side effect. Shortly after he started on the meds, he stopped eating. He went through test after test after test. They changed his meds around, they prescribed more. They tried everything they could, but he just would not eat. He was never hungry and always felt bloated. About a week before he passed, my mother was with him, and he told her that he felt bloated. My mom told him to burp and he’ll feel better. That was when he told her that he had never been able to burp for his entire life. I don’t know if the Dr’s knew this or if they just didn’t think it was a big deal. But he died a week after that, and I heard that story. I’m kicking myself because I feel like I could’ve saved my grandfather. I didn’t know he had DBR. He died because he could not burp. The meds were making him bloated all the time. His brain was telling him he was full, even though he hadn’t eaten anything, and so he starved, all because he could not burp. Maybe if there was more awareness it wouldn’t have happened. I brought this up with the family. It turns out that my aunt and her son also have DBR and never knew what it was. So, it’s either a massive coincidence, or its hereditary. Either way, we had never really talked about it before, and I don’t think any of us realized how serious it can become. We just thought of it as a little discomfort, but those who have it and don’t know why they can’t burp could end up suffering the same way my grandfather did.

    1. Thanks for sharing your story Andrew and sorry to hear about what happened to your grandfather. I’ve never heard of DBR having such a major impact before, and we can only hope that health professionals might actually sit up and notice after a case like his.

      It’s the first time that I’ve heard anyone report a noticeable hereditary link in their family, too.

  10. holymoly…I saw the blog entry before and somehow forgot to check for an update. already that there s a medical shortterm solution for our problem is great news!!!

    My grandma cannot burp either and my brother was not able for a long time … somehow he learned to burp. unluckily I did not yet.
    I thought that hypnosis might help to relax that muscle bc (rarely) but sometimes an accidential small burp escapes my throat (which always makes me super happy :) ) so physically it is possoble to burp..what do you think…any experience with this?

  11. Just wondering if anyone has had any new experiences with the surgery. Is Chicago still the only place to go in the U.S for this?

    1. Hi Tim! I was just about to begin a new comment because I have found another doctor in the US who is willing to provide the injections for us! I live in San Diego and have flown out to Dr. Bastian twice now for my injections (initially in May 2017, wore off in August, returned to Illinois in October 2017). I can’t continually afford to fly out to Illinois to have injections, so I was doing my research and met with Dr. Sunil Verma through UCI (University of California, Irvine).

      Dr. Verma is very well known, has done a lot of groundbreaking research, and has been on TV shows like The Doctors. He works with the crycopharangeous muscle quite a bit, but for swallowing issues only. When I explained my problem and success through Botox, he was actually very open minded, which was a first for me besides with Dr. Bastian. It also helped that he was very familiar with Dr. Bastian’s work and said that he actually looks up to him as a role model in their field! He had never performed Botox on the muscle before, but said that it sounded simple enough. He said he would absolutely be willing to do the procedure for me, but first wanted to speak with Dr. Bastian to have him walk him through the procedure beforehand.

      My second round of Botox is kind of wearing off, kind of not, I’m not totally sure. I left Dr. Verma’s office saying that I would contact him if I need the procedure done again (hoping that I would not). I’m not sure if he has spoken to Dr. Bastian yet, but I would encourage anyone on the west coast to speak with Dr. Verma’s office before flying out to Illinois!

      Dr. Sunil Verma
      250 E Yale Loop, STE 200
      Irvine CA 92604
      Phone: 714- 456-7017
      http://ent.uci.edu

    1. Hi Amelia. There actually isn’t a test to diagnosis the issue, which is what makes it hard for a lot of doctors to understand what we’re going through and what the problem is. Dr. Bastian bases his diagnosis entirely off of our subjective complaints and how we describe our symptoms. Once you under go the Botox injection and confirm that you get relief, that confirms the diagnosis as well. The one test that Dr. Bastian does do it a swallow study, where he puts a tube with a camera down your nose and into the throat. He has you make various sounds and eat applesauce, a cracker, drink water, etc. This is to confirm that we are able to swallow normally and the issue is not dysphagia (swallowing issues). Hope this helps!

  12. Is there anyone here who had permanent relief after one Botox injection? I am seriously considering taking my 15yr old son to Chicago. His main problems are an excess of phlegm, the noisy gurgles, and pressure he cannot expel. This causes major digestive issues, flatulence, and constipation due to the very strict diet he follows to try and decrease gas. He feels miserable most of the time.

  13. Oh my! What a breath of fresh burpy air!

    Can’t believe this is real and my suspicions are confirmed by so many others. At 37, I am currently undergoing a seriously life-impacting change to my body which seems like it started around 3 years ago but actually could be much much longer than that.

    Right now, after every meal or drink, I bloat up and fart like crazy often within 5-10 mins. Sometimes it’s physically speaking quite easy to fart but most of the it’s not and I get extremely agitated and unable to concentrate or do anything else as I flare up. I have to confess, I don’t get any pain. Just bloating/flatulence and discomfort that takes over the mind.

    I have spent close to £10,000 working with some of the best gastroenterologists in the world who right now seem to think it’s a psychological problem (chicken/egg, hello???). I have been tested for SIBO – negative. Had a colonoscopy – negative. Tried a seriously strong anti-biotic + probiotic medication routine for a while – negative results. Tested for candida and all sorts of fungal diseases – negative. Tested for allergies – negative. Have tried different diets, cut out fizzy, cut out milk, cut out gluten, sugar, everything. All I have done by doing the above is to ruin the quality of my life even more. All of this has turned out to be BS and now the gastroenterologist wants me to speak to a psychologist who specialises in IBS type issues.

    I have often remarked to my wife that with this new problem of mine, I noticed I don’t burp as much as I used to. For a while (I would say my best years, I would burp loud but now they are almost non-existent). She agreed but we put the idea to bed. Now I’m seriously considering visiting Dr Bastion because actually, thinking about it, I’ve suffered from a sore bloated belly after every meal for pretty much the last 15 years and to varying degrees. Further to that, my parents remind me how I was the horror child who cried over a hurting tummy throughout my early childhood. Have I always had a dysfunctional burp reflex to some degree?

    It’s wonderful when you put 2 and 2 together and realise something no Doctor or expert would even consider!

    Chicago, here we come!

  14. Appreciate this article and the other one and the illustrations. They explain perfectly what I have suffered my entire life. The gurgling was not frequent when I was younger but now at 53, I am having symptoms every day. Gurgling starts around noon and if I can’t stop it, it gets worse and worse causing painful bloating, gas, pressure, and a terrible pain in the middle of my back. The only relief is to lie flat on my back. For really bad episodes, it wipes out my body and I feel ill and sore until I wake up the next morning to start all over again in a few hours. It’s really affecting my quality of life. My question is, has anyone run across any other doctors who do the Botox treatment in the US? KW – did you run across anyone else in your research? I live on the east coast and am trying to find a Dr. closer. Google searches have not been successful. Thank you.

    1. Hi JD! The only doctor I had initially heard about in the US was Dr. Bastian in Chicago. Being from California, I found a reputable doctor out here and convinced him to do the procedure as well (Dr. Verma in Irvine). Unfortunately, I didn’t do any investigating on other east coast doctors because I am not from the area.

  15. Hello fellow nonburpers!

    Has anyone been prescribed “baclofen”? I have just been to a specialist here in Stockholm/Sweden and I’m starting a two week trial period of eating baclofen 10mg. Hopefully it will stop the lower esophageal sphincter from constantly letting gas out from the stomach up in my throat thus relieving me from the unpleasant feeling of pressure in my throat/chest.

    It wasn’t easy getting ahold of a doctor who would prescribe this to me since it’s not a common drug used within the gastrointestinal medicine.

    I will let y’all know if it’s working!!

    1. Hi Emilia! I did try Baclofen and unfortunately it didn’t do a thing for me. Something important to note is that the inability to burp is a dysfunction of the upper esophageal sphincter, not lower.

      1. Hi I have been following this blog for some time now. I am having the opp this year after waiting along time and having ever test done. The biggest problem I have is the trapped wind hurts like hell. I end up putting my fingers in my mouth to make me burp. The question I have does anyone else fart all the time too ??? It’s so embarrassing :(. But if I try to hold it In i swell up like a beach ball and it hurts like hell. Anyone else have this problem ?? I also have trouble flying because of this.

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