R-CPD Esophageal Findings
The details of the following photos may support the R-CPD diagnosis, though they should not be considered diagnostic. Take note that all photos are non-channel scope images; that is, the scope is not able to insufflate (blow in) air. The significance: the esophagus is typically collapsed around endoscopes inserted into them and air is pumped in through a tiny channel in order to gently expand the esophagus so that its walls can be seen. Here, the air the patient cannot belch/evacuate is doing that work for us. And the esophagus remains open for extended time, the full duration of the examination. Four findings are being evaluated and compared with normal esophagoscopy images (also without insufflated air to make the comparison valid):
1) Reflux from the lower esophagus, suggesting damage to the lower esophageal sphincter from constant upward pressure trying unsuccessfully to belch.
2) What we call an “aortic shelf,” meaning that rather than an indentation of the medial circumference of the aorta, dilation of the esophagus drapes its mucosa across the upper surface of the esophagus, making a “horizontal shelf.” Keep in mind again that this is without insufflating any air.
3) Continuous patency with very infrequent, partial “clamping” down of the lumen or, often no closure at all, suggesting that there is sustained opening pressure of unbelchable air and/or that the contractile ability of the esophagus is reduced, in similar fashion to what happens to an overly-distended urinary bladder.
4) Upper esophageal dilation in a medial-lateral axis so that the upper esophagus becomes stretched in an exaggerated “oval” rather than a more gentle oval or even “circle.”
Esophageal Stretching by Unburpable Air in R-CPD
This young man has had the classic syndrome of R-CPD lifelong. His esophageal findings at the end of a videoendoscopic swallow study are classic. The esophagus is mostly a collapsed muscular tube in young people, yet his esophagus is widely open on a continuous basis due swallowed air that he cannot burp up.
Typical view of an esophagus (1 of 4)
Typical view of an esophagus (1 of 4)
Lower esophagus (2 of 4)
Lower esophagus (2 of 4)
Stretched mid-esophagus (3 of 4)
Stretched mid-esophagus (3 of 4)
Esophagus stretches laterally (4 of 4)
Esophagus stretches laterally (4 of 4)
More Interesting Esophageal Findings of R-CPD (Inability to Burp)
Stretched Esophagus (1 of 4)
Stretched Esophagus (1 of 4)
Tracheal Wall (2 of 4)
Tracheal Wall (2 of 4)
Over-dilation (3 of 4)
Over-dilation (3 of 4)
Bronchus (4 of 4)
Bronchus (4 of 4)
The Esophagus Doesn’t Like Being Stretched for Years Due to Untreated R-CPD
Lateral dilation from R-CPD (1 of 3)
Lateral dilation from R-CPD (1 of 3)
Lateral dilation in the upper esophagus (2 of 3)
Lateral dilation in the upper esophagus (2 of 3)
Medial-lateral stretch (3 of 3)
Medial-lateral stretch (3 of 3)
Emerging Esophageal Findings
Aortic shelf (1 of 3)
Aortic shelf (1 of 3)
Bony spur emerges due to stretched esophagus (2 of 3)
Bony spur emerges due to stretched esophagus (2 of 3)
Stretched esophagus due to unburpable air (3 of 3)
Stretched esophagus due to unburpable air (3 of 3)
Example 2
Saliva bubbles (1 of 5)
Saliva bubbles (1 of 5)
Symptoms point to GERD (2 of 5)
Symptoms point to GERD (2 of 5)
Pocket in the aorta (3 of 5)
Pocket in the aorta (3 of 5)
Trapped air expands the esophagus (4 of 5)
Trapped air expands the esophagus (4 of 5)
Exaggerated laterally-stretched esophagus (5 of 5)
Exaggerated laterally-stretched esophagus (5 of 5)
Abdominal Distention of R-CPD
Gastric Air Bubble (1 of 3)
Gastric Air Bubble (1 of 3)
Bloated Abdomen (2 of 3)
Bloated Abdomen (2 of 3)
Non-bloated Abdomen (3 of 3)
Non-bloated Abdomen (3 of 3)
Can’t Burp: Progression of Bloating and Abdominal Distention – a Daily Cycle for Many with R-CPD
This young woman has classic R-CPD symptoms—the can’t burp syndrome. Early in the day, her symptoms are least, and abdomen at “baseline” because she has “deflated” via flatulence through the night. In this series you see the difference in her abdominal distention between early and late in the day. The xray images show the remarkable amount of air retained that explains her bloating and distention. Her progression is quite typical; some with R-CPD distend even more than shown here especially after eating a large meal or consuming anything carbonated.
Side view of a bloated abdomen (1 of 6)
Side view of a bloated abdomen (1 of 6)
Front view (2 of 6)
Front view (2 of 6)
Greater Distention (3 of 6)
Greater Distention (3 of 6)
Front view of bloating stomach (4 of 6)
Front view of bloating stomach (4 of 6)
X-ray of trapped air (5 of 6)
X-ray of trapped air (5 of 6)
Side view (6 of 6)
Side view (6 of 6)
Shortness of Breath Caused by No-Burp (R-CPD)
Persons who can’t burp and have the full-blown R-CPD syndrome often say that when the bloating and distention are particularly bad—and especially when they have a sense of chest pressure, they also have a feeling of shortness of breath. They’ll say, for example, “I’m a [singer, or runner, or cyclist or _____], but my ability is so diminished by R-CPD. If I’m competing or performing I can’t eat or drink for 6 hours beforehand.” Some even say that they can’t complete a yawn when symptoms are particularly bad. The xrays below explain how inability to burp can cause shortness of breath.
X-ray of trapped air (1 of 2)
X-ray of trapped air (1 of 2)
Side view (2 of 2)
Side view (2 of 2)
Dramatic Lateral Dilation of the Upper Esophagus
Remarkable lateral dilation (1 of 3)
Remarkable lateral dilation (1 of 3)
Dilated upper esophagus (2 of 3)
Dilated upper esophagus (2 of 3)
Aortic shelf (3 of 3)
Aortic shelf (3 of 3)
Dramatic Dilation of the Esophagus in a Person with R-CPD due to Buildup of Swallowed Air that He Cannot Belch to get Rid of.
View of the mid-esophagus (1 of 2)
View of the mid-esophagus (1 of 2)
View of the mid-esophagus (2 of 2)
View of the mid-esophagus (2 of 2)

R-CPD in X-ray Images
Why do persons with R-CPD experience such daily misery? These X-ray images provide the explanation, as well as the rare “abdominal crisis” in this group is also explained.
In a new video format, Dr. Bastian will discuss various photo essays found across Laryngopedia, and provide in-depth descriptions on their origins and what is going on behind the scenes during the time of capture.