Some patients develop an inability to burp (abelchia) because a muscle that surrounds the bottom of the throat (the cricopharyngeus) remains overly tight when they attempt to allow air to pass upwards through their food pipe. This has been recently termed as “retrograde cricopharyngeal dysfunction. (RCD)” (Karagama, 2021). Studies have demonstrated that a single dose of botulinum toxin A (Botox) injected into the muscle under general anesthesia helps resolve this condition in virtually all patients. The Botox is thought to work by causing relaxation of the muscle. It has been speculated that even when the Botox wears off after 3-4 months that the patients’ ability to burp remains because the cricopharyngeus muscle has become “retrained.” (Hoesli, 2020).
This blog reports a 19-year-old patient who complained of an inability to burp his entire life. This caused him to feel discomfort after large meals. The patient had heard about Botox therapy for his condition and was considering undergoing this procedure. This patient had previously demonstrated great success in using hypnosis for therapy of his anxiety and insomnia. I proposed to the patient that improvement of his abelchia could be accomplished through use of hypnosis rather than administration of Botox. I speculated that hypnosis could be beneficial in this setting because it can affect skeletal muscle function.
Initially, the patient tried to relax his crycopharyngeus muscle by asking his subconscious to help but this did not help him burp. I suggested that he imagine dilating a balloon within the muscle or imagine a warm liquid applied to the muscle, but these imageries did not help.
The patient then volunteered that when he tries to burp, he begins to gag, and he has worried that he might throw up. Therefore, I suggested that he imagine applying a numbing cream to his throat when he tries to burp, so that his gag reflux would not be elicited. The patient reported that application of the imagined cream reduced his propensity to gag, but he still could not burp.
Finally, I suggested that the patient ask his subconscious to relax his cricopharyngeus muscle at the same time that he numbed his gag reflex. This allowed the patient to burp small amounts of air. I recommended that the patient continue to practice the latter techniques with the suggestion that as a mind/body skill hypnosis application improves with practice.
Hypnosis can help resolve functional symptoms (i.e., symptoms that occur without a known physiologic cause) in the head and neck, such as vocal cord dysfunction (Anbar, 2016). In my experience it also has helped with cervical dystonia, bruxism, and rhinitis. In this blog we present a case report of hypnosis therapy leading to resolution of RCD.
As RCD resolves with both hypnosis and a single dose of Botox, which wears off after 3 months, it is likely that RCD represents yet another functional disorder that can resolve with a psychological approach. Thus, muscle “retraining” is a less plausible explanation for resolution of RCD following Botox administration. Such retraining would seem to require some repeated muscular movement, which is rendered impossible because of the Botox effects.
It is possible that the initial suggestions to relax the cricopharyngeus muscle were unhelpful because the patient was afraid that gagging might cause him to throw up. Thus, in order for those suggestions to take effect, the fear of emesis needed to be addressed by teaching the patient to hypnotically suppress his gagging reflex.
Take Home Message
In conclusion, successful hypnosis therapy must involve addressing the underlying cause(s) of symptoms. In this case, the therapy addressed both relaxing the muscle and the fear of gagging. A nonspecific approach, such as asking the subconscious to solve the issue, was ineffective.
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Anbar, Ran D., Fernandes BA. 2016. “Vocal Cord Dysfunction.” In: Gary R. Elkins (ed), “Handbook of Medical and Psychological Hypnosis: Foundations, Applications, and Professional Issues.” New York, NY: Springer Publishing Company, pp. 429-433.
Hoeseli, Rebecca C., Melissa L. Wingo, and Robert W. Bastian. 2020. “The Long-term Efficacy of Botulinum Toxin Injection to Treat Retrograde Cricopharyngeus Dysfunction.” OTO Open. 4 (2): 2473974X20938342.
Karagama, Yakubu. 2021. “Abelchia: inability to belch/burp-a new disorder? Retrograde cricopharyngeal dysfunction (RCPD).” European Archives of Otorhinolaryngology. 278 (12): 5087-5091.