Retrograde Cricopharyngeal Dysfunction: An Under-recognized Cause of Lifelong Inability to Belch and Chronic Postprandial Bloating

Retrograde cricopharyngeal dysfunction (RCPD) is an increasingly recognized disorder characterized by inability to belch, often accompanied by postprandial bloating, gurgling sounds, nausea, and excessive flatulence. We describe a 24-year-old woman with lifelong inability to belch and progressive gastrointestinal symptoms beginning in adolescence. Upper endoscopy revealed no structural cause. Based on the characteristic symptom profile, a working diagnosis of RCPD was made, and she was referred for direct laryngoscopy with cricopharyngeal botulinum toxin injection. Within days, she regained the ability to belch and experienced marked improvement in her associated symptoms. This case highlights the importance of considering RCPD in patients with lifelong inability to belch and otherwise unrevealing evaluation. Although diagnostic and treatment approaches remain evolving, recognition of the characteristic clinical presentation may facilitate appropriate evaluation and access to effective therapy.