Hello, I'm Robert Bastian from Bastian Voice Institute and Laryngopedia, and my topic for
this session is chronic nausea that's unexplained. So let me go straight to a share screen and tell
you what it is I'm thinking about. There are people who have chronic nausea and nobody can
tell them why. They've been to physicians, they've done testing and they're left with this problem
of nausea. Nobody can explain it. Well, there are a lot of causes of nausea: medication, food poisoning,
a G-I bug, gastroenteritis, pregnancy, motion sickness and other things. But sometimes people go through
that list and they still, they don't have an explanation. “Why am I nauseated so much?” Well,
there is an un overlooked cause of nausea. Right here, the inability to burp or R-CPD. What is R-CPD?
It stands for Retrograde cricopharyngeus dysfunction, the cricopharyngeus muscle is
right here in the neck, it's the upper esophageal sphincter, it's a circular muscle that has
to let go to let us swallow. But it also has to let go to let us burp and vomit. So in people who can't
burp, a percentage of them have these terrific symptoms, G-I symptoms, and each symptom can be a
door into the disorder. Each symptom can be worked up on its own. People don't think to clump them
all together under one single explanation of this inability to burp. So, if this is a new thought
to you and you want to know more, you can just go to your browser and just type in "R-CPD" and
quite a bit will come up, beginning with our first publication on the disorder back, I think,
in 2019. Or you can go to Laryngopedia.com here on the screen, just type that into your browser, and
then once you get to Laryngopedia, it's an online encyclopedia, type R-CPD and a page comes
up that's got comprehensive resources. Well, what is R-CPD in a nut shell? As I said, it's a problem with
the upper esophageal sphincter that won't let go to let you burp or vomit. So the symptoms, the big
four are: 1) can't burp 2) gurgling it can be internal that you can sort of almost hear it inside
yourself or feel it inside yourself, but very often it's audible at least at times. Sometimes just to
people sitting near you, but sometimes it can be across a large room if it's very quiet. Sometimes
it can be quite embarrassing this gurgling. 3) Bloating means that feeling of being distended
and over full primarily abdominal, there can be pressure in the chest and the neck as well. Also
bloating and many especially towards the end of the day their stomachs stick out even with the
bloating. And then 4) Flatulence which can be major. So those are the big four. If you fit those four and
it's basically lifelong, I think at least until further discussion you qualify for this disorder
called R-CPD, that's a very clear four-part syndrome there are a lot of other symptoms that
are a little less universal but still very common. So in this idea, the idea is that the disorder R-CPD
it has these four main doors, gurgling— can't burp is central—gurgling, bloating and distension
and flatulence. And again they can have slightly more or less prominence for an individual. And
so sometimes people go through one door, and sometimes they get to the diagnosis through
the doorway of nausea, and that's what I'm trying to do is to find that small number of people out
there in the world who are so troubled by nausea but they actually have the other symptoms also.
Well an anecdote; (here's one) a young woman—I think I saw her three or four months ago now—she is one
of a thousand one hundred and ten people in our group here at Bastian Voice,
treated about a thousand one hundred and ten as of November 2022, and so this one particular
young woman, she walked through the nausea door. She searched it online and it led her finally to
R-CPD. She had tried for years to figure out what was wrong with her, all of her abdominal symptoms
GI symptoms and everything. Well, she came and we did the successful treatment which is a simple
injection of Botox into the upper esophageal sphincter. It's all over the internet now
if you want to read more. Again, go to Laryngopedia.com But she said to me, “You know, I saw so many doctors
and I did so many things, and finally I said to one of my doctors, 'I'm going to go do this Botox
treatment.’" I think she was from out of town, and she reported that the doctor said
to her, “Well fine, go do that if you want to but it's not going to solve your nausea.” Well, we did
the injection and a week later we were in touch and she was just overjoyed to report, I think she
said, “For the first time in years I'm no longer nauseated!" She was a person who really was a bit
nauseated all day. It's a little more common for people who say, “Well the nausea is when after I
eat, you know frequently after I eat I feel kind of a little nauseated." The other group are people
who say, “Well, I have the nausea after Thanksgiving dinner, or if I eat too much, or if I have, you know,
the wrong things then I'll be nauseated." So it's a spectrum disorder, so not everyone has the
same degree. But again that single individual she found the diagnosis through the doorway
of nausea, and so my thinking here is to say to you; if you have undiagnosed nausea and you've done
your work to try to get it diagnosed and nobody can help you, think about this disorder. Educate
yourself about retrograde cricopharyngeus dysfunction and see if you
match it, then call around in your area and find a physician who treats people who can't burp. Call
primarily larger ENT groups in your area and ask the scheduling person or the triage nurse, “Does
any of your Physicians help people who can't burp?" And my hope for you is that if you have
chronic nausea or recurring nausea, that help is on the way. So thank you very much for listening!