Podcast Episode Summary

Unexplainable — "Everyone does it. Why can’t I?"

Podcast: Unexplainable (Vox)
Air Date: February 9, 2026
Host: Sally Helm
Guest: Noelle King (host of "Today Explained")
Featured Expert: Dr. Robert Bastian (Laryngologist)
Description:
This episode dives into the strange, under-recognized world of people who physically cannot burp—a condition only officially named in 2019, and known online as "no-burp syndrome" or, medically, retrograde cricopharyngeus dysfunction (R-CPD). Host Sally Helm reveals her own struggles with the condition, explores its physiological and psychological dimensions, and documents her journey to try a novel, potentially permanent cure.

Episode Overview

The episode explores the mystery of “no-burp syndrome”: why some people cannot burp, why this condition was ignored by the medical field for so long, how it profoundly affects quality of life, and why a surprising cure—Botox injections—may offer lasting relief for some. The conversation is driven by Sally’s personal experience, interviews with others affected, and insights from Dr. Robert Bastian, a key physician in identifying and treating the syndrome.

Key Discussion Points & Insights

1. What is “No-Burp Syndrome”? [02:40–06:22]

• Symptom Descriptions: People describe severe bloating, air trapped in the gut, pain, and odd throat noises. Sally shares audio montages of “froggy” or “ribbit” sounds made by those affected.

  "There were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable." — Sally Helm [05:25]

• Revelation: Sally reveals she herself cannot burp, explaining how strange, painful, and isolating the experience is.
• Naming the Syndrome: The condition was only described in the medical literature in 2019 as "retrograde cricopharyngeus dysfunction" (R-CPD). [07:08]

  "It’s really easy to recognize...I can’t burp. That is the problem. It’s very easy to describe. And yet, it was not named for many, many years." — Sally Helm [07:19]

2. Medical System Blindspots [06:35–09:14, 17:09–18:52]

• Undiagnosed for Decades: Many suffer for years, often subjected to unnecessary, invasive tests.
• One Patient's Ordeal: Dorie Gray recounts being recommended colon removal before realizing her true issue was not being able to burp.

  "No one ever said, you know, do you burp? I never thought about not burping. It just wasn’t on my radar as a thing." — Dorie Gray [08:27]

• Medical Specialties Overlapping: The muscle involved sits at the overlap of GI doctors’ and ENT doctors’ domains, so the symptom pattern fell through the cracks.

  "It’s kind of an orphan area...it just gets a little lost." — Sally Helm on Dr. Bastian’s analysis [18:05]

3. Enter Dr. Robert Bastian—Diagnosis and Innovation [09:14–14:22]

• Laryngologist’s Curiosity: Dr. Bastian, open to patient observations, gets an email from a man whose new skydiving hobby made his symptoms unbearable.

  "My mind is one that goes to sort of solutions...I’m a strategic thinker, I’m an optionizer." — Dr. Robert Bastian [09:27]

• Understanding the Physiology: Problem lies in the cricopharyngeus muscle (upper esophageal sphincter) not relaxing to let air out.
• The Surprising Cure: Dr. Bastian proposes injecting Botox in the muscle:

  "You need to have somebody put Botox into your upper esophageal sphincter to help you burp." — Dr. Robert Bastian [13:08]

• Online Patient Community: The "no-burper" community on Reddit and Facebook is pivotal in spreading awareness and self-diagnosis, often ahead of the mainstream medical community.

4. The Odd Cluster of Symptoms [14:22–16:21]

• Beyond Bloating: Excessive gurgling, painful hiccups, high flatulence, and a high rate of emetophobia (fear of vomiting).

  "There are a few random things, like painful hiccups. Are your hiccups painful?" — Sally Helm [15:01]

5. Why Did Medicine Ignore This? [16:55–18:52]

• Measurement vs. Observation: Over-reliance on diagnostics over patient narratives delayed recognition.

  "Measurement gets respect. Observation does not get respect." — Dr. Robert Bastian [09:40]

• Self-Diagnosis is Accurate: Nearly all who self-diagnose online turn out to be correct; the diagnosis is "syndromic," based on classic clusters, not tests.

  "If patients can diagnose themselves accurately 100% of the time, then why can’t we doctors do the same?" — Dr. Robert Bastian [19:48]

6. The Botox Treatment and Why it Might Work [22:41–25:47, 29:16–35:20]

• Expected Temporary, Saw Permanent Relief: Botox (usually lasting 3–4 months) seems to “teach” some patients to burp, leading to permanent results.

  "He mysteriously kept burping...as far as I know, he is still burping." — Sally Helm [22:56] "A single Botox injection fix these people permanently. This does not make sense." — Dr. Robert Bastian [23:08]

• Sally’s Personal Account: She undergoes the procedure herself, initially under general anesthesia (for vocal safety), and narrates the anticipation and gradual success.
  • First Days: "In the 48 hours after surgery, I’m just watching every movement in my throat." [28:19]
  • First Burp: "I was in the middle of talking about something, and suddenly..." [29:41]
  • Learning to Burp: Sally describes awkward, elaborate postures that trigger burping, as she (and others) build this new muscle memory.

    "I discovered that a body posture that worked really well is...when you’re reversing a car...burp city right away." — Sally Helm [33:27]

  • Lasting Change?: The skill may last, but it’s unclear if it’s truly permanent for all.

    "Why are people still burping? My answer...has to be, well, they figured it out." — Dr. Robert Bastian [36:41]

7. On Belching as a Learned Skill [35:31–37:22]

• The Reflex Element: Dr. Bastian theorizes everyone develops some physical "gesture" to produce a burp, often unconsciously; those with R-CPD missed this learning early on.

  "Every person who burps does something just prior to the burp...I don’t like calling it the Belch Reflex because it does have some voluntary input." — Dr. Robert Bastian [35:31]

Notable Quotes & Memorable Moments

• [05:25] Sally Helm: "There were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable...some of the patients that I see with this condition have what I would call severe daily misery from not being able to burp."
• [08:27] Dorie Gray: "No one ever said, you know, do you burp? I never thought about not burping. It just wasn’t on my radar as a thing."
• [13:08] Dr. Robert Bastian: "You need to have somebody put Botox into your upper esophageal sphincter to help you burp."
• [18:52] Dr. Robert Bastian: "I would imagine that there must have been at least 15,000 major tests done on these 2,400 people before they came to us...and out of those 2,400 people, the diagnostic rate was exactly zero."
• [19:48] Dr. Robert Bastian: "If patients can diagnose themselves accurately 100% of the time, then why can’t we doctors do the same?"
• [23:08] Dr. Robert Bastian: "I have to figure out why on earth would a single Botox injection fix these people permanently. This does not make sense."
• [36:41] Dr. Robert Bastian: "Why are people still burping? My answer to that has to be, well, they figured it out."

Useful Timestamps

• [02:40] Introduction to patient symptom audio
• [05:11] Sally reveals she cannot burp
• [07:08] The condition officially named in 2019
• [08:02] Dorie Gray’s misdiagnosis, colon removal suggestion
• [09:14] Introduction of Dr. Robert Bastian
• [13:08] Botox as a treatment
• [17:09] Why this condition was missed by medicine
• [18:52] 2,400 self-diagnosed patients, zero test-based diagnoses
• [22:41] Botox’s unexpected permanence
• [28:19] Sally after her surgery, awaiting first burp
• [29:41] Sally’s first recorded burp
• [33:27] "Backing up the car" posture for burping
• [35:31] The voluntary element of burping

Episode Takeaways

• Many people suffer for years with a seemingly trivial but genuinely debilitating condition: inability to burp.
• The medical profession overlooked this issue due to overlapping specialties, a focus on quantifiable tests over patient narrative, and perhaps social discomfort.
• The solution—Botox injection into a specific throat muscle—emerged not through randomized controlled trials, but keen observation and openness to patient experience, then quickly caught fire via online patient communities.
• For many, the cure is not only rapid but potentially permanent, thanks to newly “learned” muscle control.
• At every turn, direct patient observation, self-advocacy, and crowdsourced knowledge proved more effective than traditional medical pathways.

Final Thoughts

This episode combines investigative curiosity, personal storytelling, medical insight, and genuine hope. Sally’s openness about her own experience (and some charming awkwardness with new burping skills) makes “no-burp syndrome”—an invisible misery faced by thousands—visible and legitimate. The conversation is warm, funny, and deeply human, reminding us how much patient experience can teach, and how much listening still remains unexplainably important in medicine.

For Further Listening

• Dr. Robert Bastian’s Laryngopedia: Resource for voice and swallowing disorders
• r/noburp subreddit: Community support and patient data for R-CPD

If you think you may have R-CPD, self-diagnosis can often be accurate and validated by a specialist; modern treatments may transform your life.