A Sample Letter In Support of the Little Ones With Retrograde Cricopharyngeus Dysfunction (R-CPD)
Introduction
One of the most important remaining goals regarding R-CPD is to help very young children with this terrible condition.
As background, as of May 2026, our Bastian Voice Institute group has treated more than 2,500 patients from all 50 states and 28 countries. We are adding approximately ten per week. There is still much work to do, and several major goals continue to guide our efforts:
Continue Raising Awareness Among People Who Suffer from the Disorder
Laryngopedia’s extensive R-CPD webpage remains one of the most comprehensive publicly accessible resources available. In addition, there are many educational YouTube videos (youtube.com/@Laryngopedia), articles in the popular press, and a growing number of peer-reviewed publications from our group and physicians around the world.
Continue Raising Awareness Among Medical Professionals
This includes journal publications, lectures, educational videos, and collaboration across specialties.
Reach More Gastroenterologists
Compared with the ENT community, GI physicians have generally been slower to recognize and accept the diagnosis of R-CPD.
Continue Emphasizing that Diagnosis Is Based Primarily on Recognition of the Syndrome Itself
In other words, diagnosis comes from match to a combination of characteristic constellation of symptoms—most of them GI-related—rather than from extensive testing. In many cases, unnecessary testing can delay diagnosis and contribute to “medical jadedness.”
Lower the Age of Treatment
We hope to move treatment into toddlerhood—and eventually even earlier—so that distressed children and their families do not have to endure years of symptoms before receiving help.
A small number of physicians are now willing to treat this subgroup, and we recently recruited a pediatric ENT physician to partner with me in suburban Downers Grove, in the Chicagoland area.
Some of these children struggle daily with painful bloating, obvious abdominal distention, refusal to eat, remarkable flatulence (“gas”), and other distress that parents and physicians alike may not understand. In some cases, families spend years searching for explanations because they know that “something isn’t right.” The possibility that these children might be spared years of discomfort through earlier recognition and treatment is one of the most motivating developments in this work.
To help parents advocate for their children, I’ve included below a sample referral letter modeled after one written on behalf of the child of an R-CPD patient. That 3-year-old very clearly has R-CPD based on a detailed Zoom discussion with the parents, yet they have struggled to find a physician within several hundred miles willing to evaluate and treat the condition.
<Date>
RE: Patient (DOB: ##-##-####)
Dear Sir or Madam:
I am writing on behalf of the above ___-year-old child, whom I believe has retrograde cricopharyngeus dysfunction (R-CPD).
R-CPD is an inability to burp that can produce a wide range of gastrointestinal symptoms, including gurgling noises, abdominal bloating, early satiety, feeding aversion, and excessive flatulence. In children, parents may describe “failure to thrive,” needing to “chase” the child to feed him or her, or the presence of a markedly distended “Buddha belly.” Based on detailed discussion with the parents, I believe that _______’s symptoms are highly characteristic of this disorder.
As background, R-CPD is diagnosed primarily by recognition of the syndrome rather than by extensive testing. (Many children have already undergone investigations because of abdominal distress; for example, a late-day KUB may have demonstrated remarkable intestinal air distention. While such findings may support the diagnosis, they are not necessary.)
The only truly definitive diagnostic test would be manometry performed with carbonation introduced into the esophagus, demonstrating cricopharyngeus hypertonicity. In my opinion, however, such testing is unnecessarily invasive not only in adults, but especially in a child whose symptoms clearly match the syndrome.
Instead, the standard approach is botulinum toxin injection into the upper esophageal sphincter (cricopharyngeus muscle). This procedure serves simultaneously as diagnostic confirmation and treatment. In many cases—especially in younger patients—a single injection appears capable of producing long-term or even permanent resolution, almost as though the treatment teaches the patient how to burp.
Importantly, _______’s father also has R-CPD and has benefited greatly from this treatment.
Although awareness remains limited among many gastroenterologists, the disorder is now well established in the medical literature. The first comprehensive peer-reviewed description of 51 patients was published in 2019, and additional publications have followed from multiple centers internationally. A copy of the original publication is enclosed for your review.
I have also written an open letter to gastroenterologists and continue to advocate for thoughtful, forward-looking physicians willing to help toddlers and very young children with this condition.
I would be happy to speak by phone, correspond by email, or participate in a Zoom discussion with any physician willing to assist little ___________.
Sincerely,
Robert W. Bastian, M.D.
Enclosures:
• Original description of R-CPD and its treatment
• Open letter to gastroenterologists
Share this article
My Baby Can’t Burp! This May Explain Why
- “My baby can’t burp!”
- “He/she cries with colic, sometimes for a long time.”
- “So much spitting up and even projectile vomiting!”
- “I’ve never seen such a gassy baby!”
Babies and older children with this condition are in misery, and so are their parents, with the stress of it all. The answer might be a dysfunction of the upper esophageal sphincter (Retrograde CricoPharyngeus Dysfunction, or R-CPD).
When such babies grow older, those with severe cases of R-CPD may refuse to eat, and may continue to complain of stomach distress.
In this video, Dr. Robert Bastian explains this “new” diagnosis that can cause all of these symptoms. Parents who are exhausted and depressed may find here a glimmer of hope.
