In a video posted on Reddit this summerLucie Rosenthal’s face appears focused and uncertain, as she looks intently at the camera, before it happens.
He emits a dry, croaking burp.
Then comes wide-eyed surprise, followed by a fit of laughter. “I did it!” the Denver resident says after what was her second burp ever.
“It really blows my mind that I’m introducing a whole new bodily function at 26 years old,” Rosenthal later told KFF Health News while working remotely, because as awesome as the burp was, it was now happening uncontrollably. “Sorry, sorry. Oh, my God. That was a burp. Did you hear that?”
Rosenthal is among more than 1,000 people who have received a procedure to help them burp since 2019, when an Illinois doctor he first reported the steps of the intervention in a medical journal.
The inability to burp can cause bloating, pain, gurgling in the neck and chest, and excessive flatulence as the accumulated air seeks an alternative outlet. A Reddit user described the gurgling like an “alien trying to escape from me” and the pain like a heart attack that goes away with a fart.
The procedure has spread mainly due to the increasingly loud rumblings in the Reddit’s gutsMembership in a subreddit for people with or interested in the condition has grown to about 31,000 people, making it one of the largest groups on the platform.
Since 2019 the condition has had a official name: retrograde cricopharyngeal dysfunction, also known as “abelchia” or “no-burp syndrome.” The syndrome is caused by an oddity in the muscle that acts as a gatekeeper to the esophagus, the 10-inch-long muscular tube that moves food between the throat and stomach.
The procedure to fix the problem involves a doctor injecting 50 to 100 units of Botox, more than double the amount often used for smooth forehead wrinkles — in the superior cricopharyngeus muscle.
Michael KingThe doctor who treated Rosenthal said he hadn’t heard of the disorder until 2020, when a teenager armed with a list of academic papers he found on Reddit approached him about the procedure.
It wasn’t a stretch. King, a laryngologist at Peak ENT and Voice Center, had injected Botox into the same muscle to treat people who had trouble swallowing after strokes.
He is now among the doctors from Norway to Thailand listed in the subreddit, r/nonburpareas if they were offering the procedure. Other doctors, commentators noted, occasionally laughed at them or made them feel like they were being melodramatic.
To be fair, doctors and researchers I don’t understand why the same muscle that allows food to go down does not allow air to go up.
“It’s very strange,” King said.
Even the doctors I’m not sure because many patients continue to burp long after the effects of Botox have worn off, after several months. Robert Bastiana laryngologist outside Chicago, named the condition and devised the procedure. He estimates that he and his colleagues have treated about 1,800 people, charging about $4,000 a snap.
“We’ve heard that in Southern California it costs $25,000, in Seattle it costs $16,000, and in New York City it costs $25,000,” Bastian said.
Because insurance companies viewed Botox bills as a “red flag,” he said, his patients now pay $650 to cover the drug, so it can be excluded from insurance claims.
The pioneer patient is Daryl Moody, a mechanic who has worked at the same Houston Toyota dealership for half his life. The 34-year-old said in 2015 he became “desperate” for relief. The swelling and bubbling weren’t just a painful shadow on his day; they were getting in the way of his new hobby: skydiving.
“I hadn’t done anything fun or interesting in my life,” he said.
That is, until he tried skydiving. But as he gained altitude during the ascent, his stomach swelled like a bag of potato chips in mid-flight.
“I went to 10 doctors,” he said. “No one seemed to believe that this problem was real.”
Then he came across a YouTube videos Bastian describing how Botox injections can solve some throat problems. Moody asked if Bastian could try it to cure his belching problem. Bastian agreed.
Moody’s insurance deemed it “experimental and unnecessary,” he recalled, so he had to pay about $2,700 out of pocket.
“This is honestly going to change everything,” he wrote on his Facebook page in December 2015, about his trip to Illinois.
The year after his surgery, Moody helped break a national record for being part of the largest group of people to skydive in wingsuits, the kind of equipment that turns people into flying squirrels. He’s jumped about 400 times so far.
People have been afflicted with this problem for at least a few millennia. Two thousand years ago, the Roman philosopher Pliny the Elder described a man named Pomponius who could not burp. And 840 years ago, Johannes de Hauvilla including the tidbit in a poem, writing: “Pomponius’s smoking face found no relief in belching.”
It took several more centuries before clinical examples appeared. In the 1980s, some case reports in the US described people who could not burp and did not remember vomiting. One woman, the doctors wrote, was “unable to voluntarily burp with her childhood friends when this was a popular game.”
The patients suffered a lot, even though the doctors could not find anything wrong with their anatomy. But the doctors confirmed using a method called manometry that the patients’ upper esophageal sphincters simply did not relax, neither after a meal of a sandwich, a glass of milk and a chocolate bar, nor after doctors used a catheter to inject several grams of air under the stubborn valve.
André Smootgastroenterologist at the University of Amsterdam in the Netherlands, said he read those reports when they came out.
“But we had never seen this condition, so we didn’t believe it existed in real life,” he said.
Smout’s doubts persisted as long as he and his colleagues studied a small group of patients a few years ago. Researchers gave eight patients with a supposed inability to burp a “burp provocation” in the form of carbonated water and used pressure sensors to watch how their throats moved. Indeed, air got trapped. A Botox injection solved their problems by giving them the ability to burp, or, to use the academic term, erupt.
“We had to admit that it really existed,” Smout said.
He wrote this summer in Current opinion in gastroenterology that the syndrome “may not be as rare as previously thought.” He credits Reddit with alerting patients and medical professionals to its existence.
But he wonders how often the treatment might cause a placebo effect. He pointed to studies that have found that with conditions like irritable bowel syndrome, 40 percent or more of patients receiving a placebo treatment feel their symptoms improving. There is also growing awareness of “cyberchondria,” when people desperately search online for answers to their ailments, putting them at risk of unnecessary treatment OR further discomfort.
In Denver, Rosenthal, the new burper, is open to the idea that the placebo effect might be at play for her. But even so, she feels much better.
“I had constant nausea, and it’s gotten a lot better since I had the surgery,” she said. So has the bloating and pain in her stomach. She can drink a beer at happy hour without feeling sick.
She is happy that insurance covered the procedure and is learning to deal with the involuntary burping. She cannot, however, burp the alphabet.
“Not yet,” he said.