R-CPD Neck Symptoms and “Throat Nausea”
Persons with R-CPD (Retrograde Cricopharyngeus Dysfunction)—the inability to burp or to burp adequately—experience a constellation of symptoms, each individual’s set drawing from about ten common possibilities. Alongside the inability to burp, these symptoms may include:
- Audible gurgling
- Abdominal bloating and distention
- Excessive flatulence
- Painful hiccups
- Nausea after eating
- Mechanical shortness of breath
- Hypersalivation
- Constipation
- Autonomic symptoms (such as rapid heartbeat or flushing)
A particularly prominent complaint for some is “throat nausea.” This is not abdominal queasiness, like one might feel with food poisoning, but rather a pressure sensation high in the throat that triggers an urge to gag.
This visual series depicts a hallmark feature of R-CPD: marked dilation of the upper esophagus filled with swallowed and retained air. Normally, this air would be burped out, but in persons with R-CPD, it cannot be expelled.
The retained air can push upward, creating a sense of pressure and a distinct gagging or “throat nausea” sensation. It also explains a striking procedural observation: during office upper esophagoscopy, air insufflation is unnecessary, because the patient’s esophagus is already dilated by trapped air, allowing visualization of its walls.
Photo Essay
X-Ray of Dilating Air (1 of 4)
Retained Air in Larynx (2 of 4)
Esophagus bulges anteriorly (3 of 4)
Air remains after swallow (4 of 4)
Children with R-CPD Need Champions
This four-year-old is an example of the many young children who fulfill the criteria for a diagnosis of R-CPD, but who cannot find a doctor to help. Her parents also say the following: “She was impossible to burp as an infant. She only eats small amounts, stopping due to discomfort, and is falling behind developmental markers (especially weight). Her abdomen blows up like a balloon each day. She requires daily laxative use, and passes a long stream of flatulence before moving her bowels.”This child precociously describes what is clearly throat nausea, and speaks of trouble breathing and too much “throat water.” When she has hiccups (once a week or so), they hurt a lot.For her age, this child has undergone significant testing and dietary manipulations, even medications, without any significant benefit. The friction and delay in the medical system of this family’s large city is so great, and the child’s (and her parents’) distress so intense that they are traveling hundreds of miles for the care of a physician who will treat expeditiously based upon the syndrome alone.
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