(703) Beyond Botox: The Role of Burping Therapy in Retrograde Cricopharyngeal Dysfunction

Introduction: Retrograde cricopharyngeal dysfunction (R-CPD) is characterized by the inability to belch due to failure of the upper esophageal sphincter (UES) to relax, leading to severe bloating, gurgling noises, and flatulence; cricopharyngeal botulinum toxin injection is the current standard of care, but studies report that more than 20% of patients experience incomplete resolution or recurrence of symptoms. This study aims to evaluate the feasibility and clinical efficacy of a recently introduced behavior retraining protocol ("burping therapy") utilized in conjunction with botulinum toxin injection for the treatment of R-CPD.

Methods: We performed a retrospective analysis of the clinical outcomes of 15 patients diagnosed with R-CPD who underwent a combined treatment protocol consisting of cricopharyngeal botulinum toxin injection followed by a structured behavioral retraining program ("burping therapy"). All subjects were treated between May and December, 2025 and the clinical outcomes evaluated were symptomatic improvement, restoration of the belch reflex, and need for repeat botulinum toxin injection.

Results: Of the 15 patients included in the cohort, 11 patients (73.3%) achieved full symptomatic improvement and restoration of the belch reflex, 1 patient (6.7%) required a repeat botulinum toxin injection to achieve symptom resolution, and 3 patients (20.0%) reported an incomplete response to the combined therapy.

Conclusions: Behavioral retraining is a feasible and effective adjuvant therapy for patients with R-CPD. Given the simplicity of the protocol and the favorable response rates observed in this cohort, "burping therapy" should be implemented broadly as a post-operative standard of care to maximize surgical success. Future investigation is warranted to determine its viability as a standalone conservative treatment for select patients.