I Can't Burp

I am not alone in this predicament.

Bubbles underwater texture isolated on transparent background. Vector fizzy air, gas or clean oxygen...
Justin Cox
It Hasn't Happened to Me

For as long as I can remember, I've been unable to burp. Not after taking a big, bubbly swig of La Croix, not after a night of drinking beer, and certainly not on command. It simply does not happen.

That means any air I consume, whether it’s trapped in food or beverages, or simply the air I incidentally swallow, must either pass all the way through my body (you know what I’m saying) or slowly bubble up my chest and throat in the form of audible gurgles that offer zero in the way of pressure relief. I could be burped as a baby according to my mom, but that’s beyond my memory. I was a baby after all.

It wasn’t until I started chatting up some of my burping friends recently that I even realized how frequently all you savages are actually doing this. Imagine for a moment that you’re someone who doesn’t burp. The automatic assumption would be that the audible Homer Simpson burps are the only ones ever happening. Why would we know about the near-silent, pressure-relieving ones that happen subtly and even subconsciously after meals and over drinks? The answer, for me at least, is that I pretty much had no idea.

The handful of times I’ve mentioned this to doctors, they’ve casually dismissed my concern, once even with a laugh. I’d wondered if the inability to burp might be connected to the digestive issues and stomach bloating that had become daily sources of discomfort in my life. A few years ago, I scheduled a series of gastrointestinal specialist appointments that yielded normal test results across the board. The doctor kicked me some probiotics that might as well have been placebos. I tried eliminating things like dairy and gluten, which I suppose did a little something, maybe, but even that I’m not sure about.

Having done the doctor circuit to no avail, I accepted my reality and the discomfort that came with it.

And then, about a month ago, a high school friend (one of two other non-burpers I’ve met in my life) sent me a podcast episode about a viral TikTokker who could not burp. She had been treated by an Ear, Nose, Throat doctor in Chicago who had published peer-reviewed research on a procedure that not only restored the ability to burp, but also rid her (and hundreds of others since) of the subsequent gurgling, bloating, and persistent farting — symptoms that are about as funny as they are miserable.

Dr. Robert Bastian is an ENT specialist at the Bastian Voice Institute in the Chicago suburbs who received an email from a “fellow in Dallas” five years ago. The man complained of stomach pains that had gone unsolved by gut doctors and noted that he could not burp — a combination of symptoms Bastian would encounter hundreds of times in the ensuing years; thousands if you count the online community that has coalesced around his diagnosis. This emailer was the very first, though. Bastian replied after some thought.

“You need to have someone put Botox in your sphincter muscle,” Bastian said, referencing the neurotoxic protein most commonly known for staving off facial wrinkles, but also prescribed for migraines, muscle spasms, and more. Bastian saw Botox, which is safe and FDA approved, as a diagnostic maneuver to address what he suspected was an issue with “retrograde function” in the throat. (The disorder would ultimately be called retrograde cricopharyngeus dysfunction).

Retrograde means “moving backward,” which is what a burp does when it flips a U-turn and exits through the hole from which it came. In other words, the emailer’s upper-esophageal sphincter could not open in reverse. It wouldn’t let him burp.

Botox works by relaxing the muscle and creating a window for it to retrain itself to allow air back up the burp hole. The toxin fades from the body a few months after injection, but the ability to burp remains permanently in more than four-out-of-five patients, according to Bastian’s peer-reviewed research.

Sounds like quack shit, I know! But for every Rogan-hocked miracle capsule that promises MaximumBeastBrain, might there be the occasional real-life solution that’s simply not yet absorbed by the medical community? In fact, doesn’t every single medical advancement in history inherently start that way? If you’ve spent a lifetime unable to burp, it certainly seems worth the risk.

Like the emailer, I’ve known on some level that the inability to burp must play some role in my discomfort, even as doctors breezily told me otherwise. If someone is consuming air with every ingested meal or beverage without any way to release it through the most basic of biological functions, wouldn’t that air have to build up somewhere? Isn’t the answer obvious?

Check out this x-ray of a guy who has R-CPD. The three discolorations represent large pockets of air in the stomach, the transverse colon and the descending colon. Bastian hears from people who wake up each morning with a flat stomach but appear five or six months pregnant by dinnertime. That’s fucked up!

The fellow in Dallas flew to Chicago, got the treatment, learned to burp, and took the results to Reddit, where a community of “noburpers” have gathered in his wake with Bastian’s treatment as their North Star.

There are 17,000 in that group with more joining daily — nearly all of them with stories of doctors shrugging off mention that they can’t burp. Here’s a recent post:

“I’ve found a (short term, kinda gross, bizarre) “fix.” I stick a toothbrush down my throat and make sure my head is back (so nothing comes up) and then I burp. If I do it several times a day it seems to help some. Anyone else do this?”

A recurring theme in that forum is the self-soothing process of air-vomiting, or gagging oneself to essentially force the trapped air out after every meal. Not great!

Last month the BBC ran a story about Phil Brown, a man in the UK who underwent Bastian’s Botox treatment with Dr. Lucy Hicklin, one of several international doctors offering the procedure. Brown is now entirely cured, so much so that his wife, who was thrilled by her husband's life-changing procedure, now cheekily tells him he can chill out with all the burping.

Brown is now advocating for the procedure to become available through the NHS — England’s public health system.

While writing this story, Anthem Blue Cross denied me coverage of the procedure, which I’d scheduled for next month. Only a handful of doctors in the US perform it and one of them is UC Irvine’s Dr. Sunil Verma, who is shockingly in my insurance network, which I allowed to bait me into some optimism. Verma appealed the denial via a doctor-to-doctor call with my provider but they denied it again. After that I submitted my own appeal, which was also denied.

I asked Bastian about the resistance from GI doctors and insurance providers to offer his treatment. What they would like to see, he said, is a slate of manometry tests, barium swallows, stool cultures, biopsies for gluten intolerance, and other analytical tests. But all of those fail to produce a diagnosis that can be simply obtained through observation and conversation.

He quoted Sir William Osler, who famously said “Just listen to your patient, he is telling you the diagnosis.”

“There is a test,” Bastian said. “Botox is the test that validates the diagnosis, but it also treats the disorder. It does two things at once.”

Bastian took steps to make his published research on the procedure’s efficiency open-source, meaning doctors and patients can easily access it for free, the goal being to increase awareness and implementation of the procedure, both of which are slowly happening.

For now, a diagnosed patient can fly into Chicago from anywhere in the United States, have the procedure done and return home in under 24 hours. The out-of-pocket cost without insurance is in the neighborhood of $3,000. That’s not nothing, but it’s also not the $7,000 one would pay to have it done without insurance at a large hospital like UC Irvine.

With those options on the table alongside my stack of insurance-denial letters, the question is whether to book that flight to O’Hare so I can drop a few thousand dollars on a Botox shot to the throat. Safe to say, that’s a new conundrum for me.

On one hand it’s a day trip to the midwest for a procedure that could very well transform my daily reality. On the other hand, it’s a simple outpatient procedure offered by a doctor in my insurance network that, without coverage, will cost more than the birth of my two kids combined.

Writing this is probably my way of reconciling those conflicting viewpoints. Maybe the out-of-pocket treatment becomes more enticing after I bang out 1,500 words on how gastrointestinal doctors should spare a thought for the good old upper-esophageal sphincter next time a patient hesitantly mentions that they can’t burp.

Justin Cox is the creator of the After the Deluge podcast and communications manager for a marine science nonprofit on Orcas Island in the Salish Sea.