At 52 years old in 2026, a Singaporean cybersecurity executive resolved a lifelong inability to burp after undergoing a specialized Botox procedure performed by ear, nose and throat specialist Leong Zhou Hao. The patient, who declined to use his full name, suffered from severe daily bloating, trapped wind, pain, constipation, and excessive flatulence caused by retrograde cricopharyngeus dysfunction, a rare condition formally identified only around 2019.
Daily Struggles and Years of Medical Misdiagnosis
For decades, the inability to belch meant the patient could not eat certain foods or consume gassy drinks without feeling like a pressure cooker. To find relief, he regularly self-induced vomiting in the toilet and massaged his stomach with medicated oil. From 2018 onward, he consulted a series of general practitioners and specialists across private and public hospitals, undergoing endoscopies and colonoscopies. Medical professionals initially diagnosed him with gastroesophageal reflux disease or irritable bowel syndrome, prescribing medications that failed to ease his symptoms.
Discovering Retrograde Cricopharyngeus Dysfunction Online
The breakthrough came two years ago when the patient discovered retrograde cricopharyngeus dysfunction through an online Reddit forum. After a private gastroenterologist expressed unfamiliarity with the condition, the patient eventually located a published research paper written by Leong Zhou Hao, an otorhinolaryngology consultant at Singapore General Hospital. Armed with this knowledge, he secured a polyclinic referral to see Leong, who officially confirmed the diagnosis of retrograde cricopharyngeus dysfunction, also known as no-burp syndrome.
Did You Know?
Humans swallow air while eating, drinking, or talking, which normally triggers a brain reflex that relaxes the oesophageal sphincter muscles to let gas escape as a burp. In patients with retrograde cricopharyngeus dysfunction, this reflex fails to develop properly, leaving preliminary data suggesting the condition could affect up to 22% of people.
Botox Treatment
To treat the condition, Leong injected botulinum toxin into the upper oesophageal sphincter muscle to relax it and allow the patient to belch. Prior to the March procedure, the surgeon performed an endoscopy to rule out any esophageal blockages. The patient elected to undergo general anesthesia to ensure the site could be treated directly. While each Botox injection typically lasts about three months, doctors encourage patients to practice burping so the natural reflex can redevelop permanently.
However, because exact prevalence figures remain uncertain, accurate diagnosis depends entirely on specialist recognition of the upper oesophageal sphincter dysfunction.
Six Months After the Oesophageal Sphincter Procedure
Six months following the procedure, the patient reports a complete absence of abdominal pain and bloating, noting that he can now drink lattes and smell food he ate hours earlier without discomfort. Leong noted that while injection effects last roughly three months, most patients maintain the ability to burp long term.
Botox Injection Treats Rare No-Burp Syndrome
What is retrograde cricopharyngeus dysfunction?
Also known as no-burp syndrome, it is a rare and underdiagnosed digestive condition formally identified around 2019 where individuals cannot physically belch due to an undeveloped reflex in the oesophageal sphincter muscles.
How did the condition get treated?
Otorhinolaryngologist Leong Zhou Hao performed an endoscopy to check for blockages and then injected Botox into the patient’s upper oesophageal sphincter muscle under general anesthesia to relax it.
What were the long-term results of the Botox injection?
Six months after the procedure, the patient reported comfortable burping, no abdominal pain or bloating, and the ability to consume lattes and gassy drinks freely without self-inducing vomiting.
How has increased awareness of rare digestive disorders changed the way hospitals diagnose chronic bloating?
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