Trouble Belching? It Could be Due to Retrograde cricopharyngeus dysfunction (R-CPD)
Retrograde cricopharyngeus dysfunction (R-CPD) is a somewhat newly described syndrome that could explain an inability to belch or burp.
Functional dyspepsia (FD) is a chronic sensation and movement disorder of the upper digestive tract. This means that those with FD perceive pain and discomfort, and often have delayed gastric emptying or other esophageal dysmotility. It is referred to as functional due to the fact there are no associated structural abnormalities or damage.
Symptoms traditionally include heartburn, burping, abdominal pain, fullness, loss of appetite, bloating, regurgitation, nausea & early satiation. Most patients experience more that one of the above symptoms.
The cause of this functional motility disorder is unknown, however, multiple hypotheses are being investigated including possible excessive acid secretion, inflammation of the duodenum, food allergies, and H. pylori infection.
FD is typically diagnosed after ruling out more dangerous conditions such as peptic ulcer disease or H. pylori gastritis. Because functional dyspepsia is due to uncoordinated and even ineffectual emptying of the upper digestive tract, conventional tests such as X rays and upper endoscopies typically come back normal. A nuclear imaging test called a gastric emptying study may reveal a diagnosis of delayed gastric emptying, but cannot reveal the diagnosis of functional dyspepsia.
A recent survey showed that 10% of the adult population and 12% of adults in the US report symptoms of functional dyspepsia. Additionally, adults who reported having symptoms of functional dyspepsia also reported having poorer quality of life.
Lifestyle and dietary modifications can be used alone or in combination with a varied of prescription treatment options.
Lifestyle and dietary modifications include cutting out or limiting foods that the patient directly associates with unwanted symptoms. If those foods are unclear some common irritants include milk, caffeine, fatty/fried foods, mint, and other acidic foods (tomatoes, citrus, coffee, spicy foods).
Medications used to treat FC are Acid Suppressants including H2 Blockers (ex: Zantac) or PPIs (Nexium, Prilosec, Dexilant). This type of treatment is the most common and typically most effective way of treating FD, however, if there is still no relief, a tricyclic antidepressant or SSRI’s (selective serotonin reuptake inhibitors) can be used. These medications are given at a very low dose in comparison to when they are used for depression symptoms. The mechanism behind why antidepressants work for patients with functional dyspepsia is unknown but research shows that it can be effective particularly for epigastric pain.
A recent study compared a tricyclic antidepressant, Amitriptyline (AMI), and an SSRI, Escitalopram (ESC). Both medications did not result in delayed gastric emptying. For the patients treated with AMI, 53% showed improvements in FD symptoms compared with 38% of those treated with ESC and 40% treated with placebo (P = .054) To read the full study please click here.
In an additional survey, patients who were on antidepressants, either for a functional GI disorder or other reasons, reported less postprandial distress than patients not on antidepressants.
