This summer, a Reddit video showcased Lucie Rosenthal, whose face displayed uncertainty as she gazed into the camera, before finally producing a sound.

She managed a small, croaky burp.

Her reaction was one of astonishment, followed by joyful laughter. “I did it!” exclaimed the Denver resident after achieving her second burp ever.

“It’s mind-blowing that I’m introducing a new bodily function at the age of 26,” Rosenthal shared with KFF Health News while working from home, noting that while it was exciting to learn to burp, it was now happening uncontrollably. “Excuse me! Oh, my goodness! That was a burp. Did you hear that?”

Rosenthal is one of over a thousand individuals who have undergone the procedure enabling them to burp since 2019, following an Illinois doctor’s publication of the treatment in a medical journal.

Struggling to burp can lead to discomfort, bloating, chest and neck gurgling, and excessive farting as trapped air tries to escape by different means. One Reddit user compared the gurgling to “an alien trying to escape” and described the pain as akin to a heart attack that resolves with a fart.

Word of the procedure has spread, largely due to increasing conversations within Reddit. A subreddit dedicated to this condition now boasts around 31,000 members, making it one of the platform’s larger communities.

Since 2019, the condition has been officially recognized as retrograde cricopharyngeus dysfunction, with nicknames like “abelchia” or “no-burp syndrome.” It occurs due to an anomaly in the muscle that controls movement to the esophagus—a muscle that’s roughly 10 inches long and helps transport food from the throat to the stomach.

To treat it, a doctor injects between 50 to 100 units of Botox—more than double the typical amount used for smoothing facial wrinkles—into the upper cricopharyngeal muscle.

Michael King, the doctor who treated Rosenthal, mentioned that he first learned about this disorder in 2020 when a teenager, equipped with research papers from Reddit, requested the procedure.

King, a laryngologist at Peak ENT and Voice Center, had already been administering Botox in the same muscle to assist stroke patients with swallowing difficulties.

Currently, he is among a growing number of physicians from countries like Norway and Thailand listed on the subreddit r/noburp as offering this treatment. While many viewers have shown support, some doctors have been dismissive, often laughing off the problem or accusing patients of exaggerating their situation.

Doctors and researchers find it puzzling why the same muscle that facilitates the passage of food downward restrains the upward movement of gas.

“It’s quite perplexing,” noted King.

There is also uncertainty around why many individuals continue to burp long after the effects of the Botox wear off, which typically occurs within a few months. Robert Bastian, who named the condition and developed the procedure, estimates that he and his colleagues have treated approximately 1,800 cases at a cost of about $4,000 each.

“In Southern California, it’s priced around $25,000, while in Seattle, it’s $16,000, and back in New York City, it’s also $25,000,” Bastian revealed.

Because insurance companies flagged Botox expenses as suspicious, Bastian mentioned that his patients now pay $650 for the medication, allowing it to be excluded from insurance claims.

The first patient to undergo this treatment was Daryl Moody, a car technician who has worked at a Toyota dealership in Houston for half of his life. At 34, Moody shared that he became “desperate” for solutions by 2015. The bloating and gurgling weren’t just uncomfortable; they were also hindering his newfound passion for skydiving.

“I hadn’t enjoyed anything fun or exciting for quite some time,” he reflected.

That changed when he discovered skydiving. However, as he ascended, his stomach would expand painfully.

“I visited 10 different doctors,” he recalled. “None of them seemed to acknowledge that this problem existed.”

Then he stumbled across a YouTube video featuring Bastian discussing Botox’s potential in treating certain throat conditions. Moody reached out, asking if Bastian could help with his burping issue. Bastian agreed to give it a try.

Moody’s insurance viewed the procedure as “experimental and unnecessary,” leading him to pay around $2,700 out of pocket.

“This is going to completely change my life,” he posted on Facebook in December 2015, excited about his upcoming trip to Illinois for the treatment.

After undergoing the procedure, Moody contributed to setting a national record by participating in the largest group skydive while wearing wingsuits—outfits that allow individuals to glide through the air like flying squirrels. To date, he has completed around 400 jumps.

This peculiar issue has affected individuals for centuries; as early as 2,000 years ago, the Roman philosopher Pliny the Elder noted a man named Pomponius who could not burp. Similarly, 840 years ago, Johannes de Hauvilla referenced this in a poem, writing,“Pomponius’s flushed face found no relief in burping.”

A few centuries later, clinical cases began to emerge. In the 1980s, several case studies from the U.S. reported individuals who were unable to burp and had no recollection of vomiting. One doctor noted that a woman could not burp along with her friends during a game that involved belching.

These individuals experienced significant discomfort, yet tests revealed no anatomical issues. Using a process called manometry, doctors confirmed that the patients’ upper esophageal sphincters wouldn’t relax — not even after consuming a meal of a sandwich, milk, and a candy bar, nor after doctors attempted to force air underneath the troublesome valve with a catheter.

André Smout, a gastroenterologist from the University of Amsterdam, stated he remembered reading those reports when they were published.

“However, we never encountered the condition in practice, so we were skeptical about its existence,” he remarked.

Smout’s skepticism continued until he and his colleagues investigated a small group of patients a few years back. The team provided eight patients who claimed they could not burp with carbonated water to stimulate burping and monitored their throat movements with pressure sensors. They found that the air remained trapped. A Botox injection successfully alleviated their difficulties, allowing the patients to burp or, in more technical terms, eructate.

“We had to accept that it was a real condition,” Smout said.

This summer, he wrote in Current Opinion in Gastroenterology that the syndrome “might not be as uncommon as previously believed.” He credits Reddit for raising awareness about the condition among patients and healthcare professionals.

However, he questions how often the treatment’s success might be due to the placebo effect. He noted studies indicating that over 40% of patients with conditions like irritable bowel syndrome report symptom improvement following placebo treatments. Awareness is also increasing regarding “cyberchondria,” where individuals search online frantically for solutions to their health issues, leading to unnecessary treatments or increased anxiety.

In Denver, Rosenthal, now able to burp, is open to the possibility that a placebo effect might be influencing her experience. Yet, regardless of this potential, she feels significantly better.

“I used to feel constant nausea, but that has improved considerably since the procedure,” she explained. Both her bloating and stomach pain have decreased. Now, she can enjoy a beer during happy hour without feeling unwell.

She is grateful that her insurance covered the procedure and is learning to manage her involuntary burping. However, she still can’t burp the alphabet.

“Not yet,” she said.

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