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Burping is seen as 'rude'... but it's a vital bodily function to prevent pain, experts say 

Burping has long enjoyed something of a bad reputation. But, in fact, it fulfils an important biological function, allowing the body to expel a build-up of trapped gases in the upper part of the digestive tract.

Being unable to burp can cause enormous pain and distress — and the problem is so misunderstood that it was identified as a medical condition only two years ago.

Given the name retrograde cricopharyngeus dysfunction, or abelchia, the inability to burp occurs when the cricopharyngeus muscle, which sits at the top of the gullet, cannot relax to release the trapped air.

Normally, the muscle serves as a valve; it relaxes for a second when we swallow, but otherwise remains closed. It also relaxes briefly when we burp.

If air is trapped due to dysfunction of this muscle, it’s forced into the digestive tract, resulting in symptoms including gurgling noises in the throat, upper chest pain after eating or drinking, bloating and excessive flatulence. Sufferers may also feel unpleasantly full after eating.

One of those affected was Jack Brody, 20, from London. Unable to burp from birth, Jack would have to put his fingers down his throat to make himself gag to release any trapped gas after eating.

Burping has long enjoyed something of a bad reputation. But, in fact, it fulfils an important biological function, allowing the body to expel a build-up of trapped gases in the upper part of the digestive tract

But after a lifetime’s discomfort, Jack recently benefited from a pioneering procedure using Botox injections.

‘It’s a very distressing condition,’ says Yakubu Karagama, a consultant ear, nose and throat surgeon at Guy’s and St Thomas’ Hospital in London, who is pioneering the treatment and treated Jack.

Mr Karagama’s research — reported in the journal European Archives of Oto-Rhino-Laryngology — shows that most patients treated with the procedure were cured, starting to burp within 48 hours. It works by paralysing the muscles, which opens the valve to allow the gas to escape freely.

All of the 72 patients Mr Karagama treated had reported avoiding socialising because of fears of abdominal pain during eating.

‘Two patients said they contemplated suicide as a result of the symptoms,’ says Mr Karagama. 

‘Another had to wear elasticated trousers as her waistline changed so much during the day due to the gas she was unable to expel.’

If air is trapped due to dysfunction of this muscle, it’s forced into the digestive tract, resulting in symptoms including gurgling noises in the throat, upper chest pain after eating or drinking, bloating and excessive flatulence

It can be difficult to diagnose — with the symptoms wrongly attributed to heartburn or irritable bowel syndrome. In fact, diagnosis often requires tiny cameras to be inserted into the gullet to watch how the muscle behaves.

Other tests include barium-swallowing X-rays or MRIs and ‘pressure sensors’ put into the gullet, as these can detect tissue changes in the area around the muscles.

Although the cause is unknown, one theory is that it’s linked to acid reflux, with the muscle shutting down to prevent stomach acid flowing back into the throat. It’s thought that after the individual has recovered from the reflux, the brain still interprets burping as reflux, causing the muscle to spasm, trapping the gas.

The new treatment is currently only available privately, and costs between £3,000 and £5,000.

Carried out as a day case under general anaesthetic, the 30-minute procedure involves inserting a tube with a tiny camera into the gullet via the mouth, manoeuvring it down to the muscle, where the Botox is injected.

Mr Karagama’s study showed that all the patients were able to burp normally by the fourth week. 

In 96 per cent of cases, the effects lasted long after the usual three-month active time frame for Botox — indeed, he says that in the two years since the first patients were treated, none of them has needed further injections and there appear to be no long-term side-effects.

Jack Brody had believed until recently that his problem was ‘just a fact of life’. 

Researching online, he was ‘shocked to discover it was an actual condition that other people had endured’.

The article mentioned Mr Karagama as an expert, so Jack contacted him. The procedure was quick and simple, says Jack — and he began burping after 24 hours.

And while he found it difficult to swallow food for around four weeks afterwards, ‘it was nowhere near as uncomfortable as the 20 years of stomach and chest pain’ had been.

‘My life has changed unbelievably. I can eat and drink, and burping just comes naturally.

‘There are a lot of people with this problem,’ adds Jack. ‘I want to raise awareness so they realise it can be treated and that they, too, can live a normal life.’

Professor Jaydip Ray, a consultant ear, nose and throat surgeon at Sheffield Teaching Hospitals, said: ‘We have significant experience in using botulinum toxin in voice disorders and swallowing problems, and this study looks at relaxing the upper oesophageal sphincter to release trapped air. The early results are encouraging.’

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