How Botox changed the life of a man who could not burp for 52 years

SINGAPORE – Daryl was 52 when he finally learnt how to burp in 2026.

“All my life, I could not burp,” the cybersecurity executive, who declined to use his full name, told The Straits Times.

The build-up of gas made him feel terribly bloated and uncomfortable. He also suffered excessive flatulence as his body tried to expel the trapped air elsewhere.

Daryl did not think his inability to belch was a problem until he was in his mid-40s, when he started experiencing bloating, trapped wind, pain and constipation every day.

“I could not eat certain foods or have gassy drinks without turning into a pressure cooker. When it happened, I would get relief by self-inducing vomiting to expel the excess air. My colleagues could hear me gagging in the toilet,” he said.

Daryl thought he had become lactose-intolerant and because he loves his daily caffeine fix, started drinking kopi-o kosong, or black coffee.

From 2018, Daryl started seeing “a slew of GPs and specialists – at both private and public hospitals”.

“I underwent (procedures) such as an endoscopy and a colonoscopy and was told that they couldn’t really find anything serious. Some told me I had GERD while others said it was IBS (irritable bowel syndrome),” he said.

GERD, which stands for gastroesophageal reflux disease, is a chronic digestive condition where stomach acid frequently flows back into the food pipe, or oesophagus, irritating its lining.

IBS is a common, long-term digestive condition that affects the large intestine and how the gut works.

The medication that Daryl was prescribed did not help his condition at all.

“And since tests did not turn up anything serious like cancer, life went on. Whenever I felt gassy or bloated, I continued to induce gagging to rid myself of the gas,” he said, adding that he regularly used medicated oil to massage his abdomen to help ease the gas.

It was only two years ago, while browsing online, that Daryl learnt of a condition called retrograde cricopharyngeus dysfunction (RCPD) from a group on online forum Reddit.

“When I consulted a doctor in private practice and told him about RCPD, he said he had never heard of it before. To be fair, he was a gastroenterologist and not a specialist in ear, nose and throat. Again, the medication he prescribed did not work.

“So another year passed, and my bloating got worse,” Daryl said.

Applying medicated oil to his abdomen to relieve the gas became a nightly routine.

Not wanting to give up, Daryl continued his search on the internet, and this time he came across a paper on RCPD, written by ear, nose and throat specialist Leong Zhou Hao from the Singapore General Hospital.

“I told myself: ‘This is the guy. I have finally found him!’ So I went to the polyclinic for a referral letter. After so many years, I needed to reduce my financial ‘damage’,” he said, laughing.

Leong, a consultant in the Department of Otorhinolaryngology at the hospital, confirmed that Daryl had RCPD, also known as “no-burp syndrome”, which is considered a relatively rare and underdiagnosed condition, primarily because it was formally identified only around 2019.

He said humans swallow air while eating, drinking or talking.

“We have two sphincter muscles along our food passage – one right at the top and one at the bottom – and normally they are closed. When we eat, they are relaxed to let the food down. Many times the food that we eat produces gas, which travels back up the food passage, stretching the oesophagus.

“This stretch is sensed by the brain, which triggers the muscle to relax, causing a burp,” Leong explained.

He added that for some reason the reflex is not developed in some people.

According to medical literature, the exact prevalence of RCPD in the general population remains unknown, but limited preliminary data suggests it could affect up to 22% of people, with about 13% experiencing severe symptoms.

To treat this condition, Leong said botulinum toxin, commonly known as Botox, is injected into the sphincter muscle in the oesophagus to help relax it and “forcibly allow the patient to burp”.

Leong, who carried out the procedure while he was working in Australia, said the effect of each Botox injection usually lasts about three months, but the majority of patients are able to continue to burp beyond those three months. But he would ask his patients to “practise burping” in the hope that the reflex would redevelop.

The surgeon carried out an endoscopy to make sure there was no blockage in Daryl’s oesophagus before scheduling the Botox injection into his upper oesophageal sphincter muscle in March.

“I picked to go under general anaesthesia for the procedure so that Dr Leong could treat the site directly and I would be cured of my inability to burp,” Daryl said.

It has been six months since the procedure, and Daryl continues to burp comfortably without feeling pain or bloating in his abdomen.

“I never knew that when I burp, I could smell the food I had eaten a few hours before. It was liberating. I would even say it was life-changing. Now I am happy that I can go back to drinking a latte without any issues.”

Daryl also revealed that the happiest person after his treatment was his wife, “for obvious reasons”, he said, laughing.