u/ScratchGolfer1976

My take as a Chemist, not a Doctor, note I maybe wrong.

This covers, chemistry, physics and fluid mechanics etc of what I see is happening based on scientific principle’s and my background as a chartered chemist specialising in pressurised gas and liquid for over 25 years.

I touch upon why I think some symptoms occur - flying, scuba diving, exercise.

I touch upon relief mechanisms to temporarily help - pre-Botox.

I touch upon my experience…misdiagnosis, ineffective treatments.

I got my English corrected by AI.

SYMPTOMS INCLUDE…

Based on the medical literature, clinical findings, and chemistry / physics / mechanical principles associated with the inability to burp (R-CPD) and subsequent gastrointestinal gas retention, the comprehensive list of symptoms includes:

Primary Functional Deficit:

Complete inability to belch or burp.
Difficulty or inability to vomit (or doing so only with extreme difficulty/strain).

Upper GI and Thoracic Symptoms:

Loud gurgling/croaking noises:
Socially awkward, involuntary sounds originating from the chest and lower neck as trapped air strains against a closed upper esophageal sphincter.

Chest pain and retrosternal discomfort:
Pressure trapped in the esophagus and upper stomach mimicking cardiac pain.

Nausea and throat tightness:
A persistent feeling of fullness, pressure, or a "lump" in the throat, especially severe after eating or drinking.

Abdominal and Lower GI Symptoms:

Severe abdominal bloating and distension: Pronounced swelling of the abdomen that progressively worsens throughout the day (often described by patients as looking several months pregnant by evening).

Cramping and abdominal pain:
Sharp or dull colicky pain caused by stretching of the intestinal walls and mucosal ischemia.

Excessive flatulence:
The body's forced compensatory mechanism to vent the large volume of trapped air that travels down the entire gastrointestinal tract.

Constipation-like symptoms & obstruction:
Difficulty passing stool due to compressible gas pockets acting as hydraulic shock absorbers, stalled transit, and secondary stool hardening.

Compression of surrounding organs and stricture-like effects:
Massive gas-driven distension creates an internal mass effect, physically compressing adjacent abdominal and thoracic organs (such as the diaphragm, stomach, small bowel, and inferior vena cava).
This external organ compression can restrict diaphragmatic excursion (causing shortness of breath), impair venous return, and create functional "strictures" or bottlenecks where compressed loops of the bowel pinch or kink against one another under intense pressure.

Acute/Mechanical Complications (Advanced Progression):
Intense, acute colicky spasms:
Resulting from the bowel attempting to force contents past functional gas blocks.

Vomiting and reflex autonomic distress:
Triggered by extreme backward pressure.

Volvulus / Bowel Twisting:
Extreme rotational torsion (such as a 540-degree colonic volvulus) caused by massive distension, buoyancy, and mechanical torque - explained below.

Psychosocial Impacts:
Social inhibition and anxiety:
Resulting from embarrassing, loud gurgling noises, uncontrollable flatulence, and severe visible bloating.

Also pressure changes.

External Pressure Changes and Pain (Boyle's Law):

The Chemistry and Physics (Boyle's Law):
According to Boyle’s Law, the volume of a given mass of gas is inversely proportional to its pressure (P_1V_1 = P_2V_2).
When external environmental pressure drops, trapped gas inside a fixed, closed system (such as a patient with R-CPD whose upper esophageal sphincter and GI tract are trapped) must expand.

Flying on a Plane / Climbing Mountains (Altitude):
As an aircraft ascends or a person climbs a mountain, atmospheric pressure decreases significantly.
For a healthy person, this minor gas expansion is easily relieved by burping or passing gas.
For someone with R-CPD or an unvented system, that trapped internal gas expands dramatically inside the stomach and intestines, causing abdominal distension, intense pressure, and acute pain.

Scuba Diving:
During descent in scuba diving, ambient surrounding pressure increases, compressing gas spaces; however, upon ascent, external pressure rapidly drops.
If gas is trapped in the GI tract and cannot escape upward or downward due to functional blockages, ascending even a few feet causes the trapped gas to violently expand, leading to severe, debilitating gastrointestinal barotrauma ("stomach cramps" or "gut squeeze").

Exercise:
During intense physical exertion, internal intra-abdominal pressure naturally rises due to the contraction of abdominal wall and core muscles. When combined with unvented gas and a compromised venting route, this muscular compression squeezes the already pressurised, gas-distended loops of the bowel, exacerbating wall stretch, triggering mechanoreceptors, and causing sharp cramping pain.

BUT WHY…

Henry's Law:
In a healthy individual, excess gas is routinely released upwards via belching.

Because a patient with R-CPD cannot open the upper esophageal sphincter to vent gas, air accumulates continuously in the stomach and esophagus.

As gas volume climbs and becomes trapped, the internal partial pressure of gas inside the stomach increases significantly.

According to Henry’s Law (which states that the amount of gas dissolved in a liquid is directly proportional to the partial pressure of that gas above it), this escalating pressure forces a higher concentration of gases (like carbon dioxide and air) to remain dissolved in solution within the liquid chyme and gastric contents.

As this pressurised chyme moves downward into the intestines and colon, any subsequent minor drops in local pressure or changes in environment cause that supersaturated solution to rapidly "outgas"—releasing micro-bubbles of gas directly inside the lower GI tract.
This compounds the volume of gas already trapped downstream.

Why Trapped Gas Eventually Leads to Severe Pains:

Intestinal Wall Stretching and Mechanoreceptor Activation:
The wall of the colon is densely lined with stretch-sensitive mechanoreceptors (tension receptors).
When unvented gas accumulates and distends the lumen, it forcefully stretches the smooth muscle fibers beyond their physiological limits, triggering pain signals sent directly to the central nervous system via visceral afferent nerves.

Ischemia and Wall Tension:
Driven by Laplace’s Law, as the radius of the bowel increases due to gas distension, the wall tension escalates exponentially.
This severe tension can compress the tiny micro-vessels (capillaries) supplying blood to the intestinal wall, causing localised ischemia (reduced blood flow and oxygen deprivation), which is acutely painful.

Spasms and Colic:
The enteric nervous system perceives the abnormal over-distension as an obstruction emergency, triggering violent, uncoordinated, and high-pressure muscle spasms (colic) as the bowel desperately tries to force the gas and contents past a blocked or non-functional exit route.

The intersection of the colon's normal physiology, fluid dynamics / chemistry / physics, and the physical properties of gas explains how trapped gas severely exacerbates constipation and mechanical obstruction:

The Colon's Water Extraction Role:
A primary function of the large intestine is to absorb water and electrolytes, compacting liquid waste into solid feces.
Under normal conditions, a proper fluid-to-solid gradient allows gas bubbles produced by digestion to coalesce, migrate, and naturally "break out" of the fecal stream to be expelled.

The Compressibility Problem (The "Slurry Pump" Effect):
While liquids and solids are incompressible (meaning muscle squeezes directly transfer force to push them forward), gas is highly compressible.

When peristalsis attempts to squeeze a gas-filled segment, the muscle energy is wasted compressing the air pocket rather than propelling contents, acting like a hydraulic system with an air bubble.

Disrupted Transit and Stool Hardening:
Compressible gas pockets act as dead zones that absorb mechanical pushing forces, stalling the transit of waste.

Because transit slows down and stalls, the stool lingers longer in the colon, allowing it to excessively absorb water and turn into hard, unyielding masses.

The Mechanical Deadlock:
As gas accumulates and distends the bowel, it becomes trapped between segments of over-dehydrated stool.

The gas cannot easily "break out" because it is buffered by compacted blocks of feces, and the stool cannot move because the compressible gas pockets absorb all the mechanical force—ultimately, worst case, leading to severe distension, functional obstruction, and predisposing the bowel to twisting (volvulus).

Upward Venting Relieves Downstream Pressure:

Releasing gas upward (via natural burping, air vomiting or a functional venting route like an open NG tube) acts as the primary pressure-relief valve for the entire gastrointestinal tract.

By venting gas at the top, it prevents the progressive accumulation and downstream force of air that would otherwise travel into the colon, causing severe distension, high pressure, and mechanical complications like a volvulus.

Air Vomiting:

The Phenomenon:
When extreme pressure accumulates in the upper GI tract due to an inability to burp, patients often resort to "air vomiting" (either artificially by putting fingers down their throat or involuntarily triggered by extreme physiological pressure).

The Mechanism:
This involves a forceful retching or regurgitation reflex where the body attempts to relieve the catastrophic internal pressure by expelling a massive rush of trapped air.

Why The Role of a NG Tube helps in Pressure Relief:

A nasogastric (NG) tube placed in the stomach or upper gastrointestinal tract acts as an artificial venting mechanism, allowing continuous pressure release for patients who cannot burp.

Depressurizing the System:
By leaving the NG tube open to the atmosphere (open drainage), trapped gas can continuously escape before it builds up, preventing the gastrointestinal tract from turning into a closed, pressurised system.

Allowing the System to "Reset":
Unclamping or leaving the cap off the NG tube reduces gaseous distension, relieves acute abdominal pain, and allows the bowel walls, fluid dynamics, and pressure gradients to decompress and normalise.

Restoring Normal Bowel Function and Motility:

When an NG tube is left open / or air vomiting takes place etc both functioning to vent trapped gas, it removes the mechanical obstruction of compressed air.

This depressurisation relieves the "shock-absorber" effect on peristalsis, allowing (helping) normal, coordinated muscle contractions to resume, smooth out propulsion, and successfully move stool and fluids forward to restore regular bowel movements.

And here is an overview of the chemistry, physics, and mechanical principles regarding how I see trapped gas causes, worst case, the colon to twist (volvulus) in a patient with an inability to burp (R-CPD):

Creation of a Closed or Pressurised System:
An inability to burp creates a mechanical failure where gas entering normally through eating, drinking, or swallowing cannot escape upward.

When a nasogastric (NG) tube—an alternative venting route—is closed, clamped, or capped, the gastrointestinal tract becomes a sealed, pressurised system.

Gas Volume and Pressure (The Ideal Gas Law):
As gas continuously accumulates inside this closed system without an exit route, the fundamental chemistry and physics described by the Ideal Gas Law (PV=nRT) dictate that pressure, volume, or both must increase, causing the bowel to expand.

Distension and Wall Stress (Laplace's Law):
The accumulation of gas causes physical distension and volume expansion of the bowel.

According to Laplace's Law (Hoop Stress), as the radius of the colon increases, the internal wall stress increases exponentially, leading to a thinning of the bowel wall and a loss of structural stability.

Structural Lengthening and Redundancy:
Chronic or acute distension does not only expand the diameter of the colon; it also elongates it and creates redundancy, which are established surgical precursors to bowel twisting.

Buoyancy and Rotational Torque:
Gas-filled structures have a lower density, making distended segments more buoyant and mobile, behaving much like a gas-filled balloon.

Uneven gas distribution across a partially fixed and partially mobile colon generates uneven internal air distribution, creating "rotational torque" and structural instability similar to how an unbalanced submarine tilts and rotates.

Final Mechanical Torsion:
Worst case - Driven by this internal increasing gas pressure, wall stress, and rotational torque, an unstable, elongated bowel undergoes extreme rotational torsion, resulting in a severe clinical events such as a 540-degree colonic volvulus.

My experience - not personally, but those that know know………

Mis-Diagnosis (as experienced from Doctors not knowing about this disorder) include………….

Hirschsprungs
Tummy migraines
Cyclical vomiting syndrome
Floppy colon
DNA disorder
Aerophagia
Pseudo obstruction
Food allergies
SIBO and IBS
Gastroparesis
Dysmotility disorder
Functional constipation
Colon architecture issue
Neuromuscular disorder
Myopathy

Treatments, investigations etc…….., which don’t show anything….. don’t improve anything………..can included……………………

Laxatives (2020 and 2021)
Ultrasound (2020)
“Rear end” Tube placed for decompression (2020 and 2021)
Two biopsies for Hirschsprung’s disease (2020 and 2022)
Anti-spasm tablets for stomach (2020 and 2021)
Painkillers (2020 and 2021)
Piresteen Washouts (2020 and 2021)
Numerous x-rays (2019 to present)
FODMAP diet (2020 and 2021 and 2022)
Gluten / wheat diet. (2020 and 2021 and 2022)
Greens / onions / dairy / fish / wheat diet. (2020 and 2021 and 2022)
Standard Bloods (2020 and 2021 and 2022)
Genetic Bloods for REN2 (2022)
Small Intestine Bacterial Overgrowth (SIBO) antibiotics - Rifaximin for almost 200 days, including 60 consecutive days (2021 and 2022)
Numerous Barium swallow / enema x-rays (2021 to 2024)
Multiple colonoscopies (2021 and 2022)
Multiple laparoscopies (2021 and 2022)
G-Tube placed into intestine (did nothing) (2021)
Colostomy stoma placed for decompression (did nothing) (2021)
Anal manometry (2022)
Colon manometry (2022)
Gastric Emptying (2022)
pH impedance (2022)
Upper and lower colon biopsies (again) (2022)

Then, eventually got the Carbonate burp test, which was positive…(2022)

Eventually got diagnosed with an inability to burp.

Colon distended for months needlessly…..

Then his colon twisted and he given an ileostomy stoma in April 2023…….medical instructions not being followed, his Naso Gastric was being clamped closed - stopping the gas from escaping………..gas was trapped inside colon, pressure increased and twisted colon 540 degrees…..he ended up needing 5 hours of life saving and life changing surgery and got an ileostomy stoma in April 2023…….

I have been analysing the physiological failure of the colon through the lens of mechanical engineering and fluid dynamics (Chemistry - Gas Laws / Pressure etc)

Specifically, I am looking at how the inability to effectively vent gas—whether through the inability to burp or a blocked nasogastric (NG) tube—transforms the digestive tract from a functional, open-flow system into a high-pressure, unstable vessel prone to catastrophic torsion.

Thoughts and comments welcome - as this is based on experience, objective evidence and Chemistry gas laws.

1. The Intake Mechanism: Swallowing and Aerophagia

Every time a person swallows—whether it is saliva, water, or food—they ingest a small volume of atmospheric air.

In a normal system, this air is released back up the oesophagus in the form of a burp. In a patient who cannot burp, this air is forced past the stomach and into the intestines.

The Inevitable Build-up:
Every swallow adds a discrete number of moles (n.) of air to the system.

Exercise and Breathing:
During physical activity, the frequency of swallowing often increases to keep the throat moist, and the intensity of breathing can lead to extra “air gulping" (aerophagia).

This effectively "pumps" more air into the stomach, rapidly increasing the internal volume of gas in a system that has no exit valve.

Additional Catalysts:
A blocked nose forces the individual to breathe through their mouth, which significantly increases the volume of air swallowed compared to nasal breathing.

Boyle’s Law and Cabin Pressure:
Furthermore, travel in aircraft with lower cabin pressure provides a clear example of Boyle’s Law (P_1V_1 = P_2V_2). This law states that the volume of a gas is inversely proportional to the pressure exerted upon it at a constant temperature. As the external atmospheric cabin pressure decreases (during ascent in an aircraft), the volume (V) of the trapped gas already inside the gastrointestinal tract must increase to compensate. This expansion places additional, strain (pressure) on an already pressurised system, the differential pressure increases - resulting in gas (volume) expansion.

Compensatory Behaviours:
Interestingly, some individuals who cannot burp develop the habit of spitting more frequently. This is an adaptive response designed to minimise the volume of air swallowed when processing saliva, thereby attempting to limit the intake of further gas into the stomach.

2. Henry’s Law: The Migration of Dissolved Air

Because the person cannot burp, the stomach pressure is elevated. According to Henry’s Law, the amount of air that dissolves into the liquid chyme is proportional to the partial pressure of the gas above it.

Saturation:
As the stomach pressure rises from swallowed air, the chyme becomes saturated with dissolved nitrogen and oxygen.

Nucleation:
As this saturated liquid moves into the intestines, it encounters a drop in pressure. The dissolved air "breaks out" of the liquid, creating new gas pockets. These bubbles are no longer in the stomach; they are now mid-intestine, contributing to the total volume of trapped air that must be moved.

3. The Ideal Gas Law: Pressure Escalation

Once these air pockets are trapped, the Ideal Gas Law (PV = nRT) dictates the internal environment.

The Accumulation (n.)
Because the system cannot vent, the number of moles (n.) of swallowed air constantly increases throughout the day.

The Pressure Spike (P):
With a relatively fixed volume (V) in the segments of the gut and a constant body temperature (T), the pressure (P) must rise to accommodate the increasing amount of swallowed air (n.)

The Result:
The colon is no longer a transport tube; it is a pressurised tank. The internal pressure rises until it reaches the limit of the bowel wall's elasticity.

4. The Systemic Impact: How Pressure Spills Over to Other Organs

When the colon and stomach transition into high-pressure vessels, the consequences are not confined to the bowel. Because the abdominal cavity is a finite, closed space, the expansion of these gas-filled "vessels" creates a domino effect of internal organ displacement and systemic stress.

As the internal pressure (P) within the bowel rises, the colon and stomach expand, physically pushing against every neighbouring structure:

Respiratory Restriction and Breathlessness:
The stomach and the transverse colon lie directly beneath the diaphragm. As these organs distend, they force the diaphragm upward into the thoracic cavity, limiting the capacity of the lungs to inflate. The result is "air hunger" as the body struggles to complete a respiratory cycle.

Early Satiety and Nausea:
With the stomach effectively "full" of high-pressure air, there is no physical volume left for food. The chronic stretching of the gastric wall triggers mechanoreceptors that send persistent signals of nausea / fullness to the brain.

Heart Palpitations:
The stomach and colon can physically compress or shift the position of the heart and the major blood vessels. Additionally, the extreme stretching of the oesophagus and the diaphragm can irritate the Vagus nerve, which can manifest as heart palpitations or a racing pulse.

Impaired Motility:
When the walls are under high hoop stress from internal air pressure, the muscular layers become overstretched and thinned. This "stuns" the gut, causing peristalsis to fail. The bowel cannot squeeze the gas and stool forward because the wall tension is too high, creating a feedback loop where the gas remains trapped, pressure builds further, and pain intensifies.

5. The "Submarine" Effect and Mechanical Torque

The presence of these air pockets can (in most severe cases) turn the colon into a potentially dangerous, buoyant system:

Buoyancy vs. Mass:
The air pockets act as "ballast tanks," making specific segments of the colon abnormally buoyant. While the dense stool remains heavy, the air-filled sections tend to "float" upward in the abdominal cavity.

Organ Distortion and Stricture:
As the gas-filled segments expand, they exert extrinsic pressure on adjacent loops of bowel. This can create distortion / movement, effectively pinching or creating "functional strictures" where healthy bowel is compressed by the distended segment. This narrowing in effect acts as a secondary obstruction, further preventing the passage of gas or stool.

The Torque Moment:
If the colon is redundant (long) or surgically manipulated (as in a colostomy), the disparity between the buoyant gas-filled sections and the heavy, stool-filled sections creates a physical moment arm.

Torsion:
As the pressure (P) increases, the hoop stress on the bowel wall rises. This tension, combined with the gravitational torque of the "floating" vs. "heavy" segments, causes the bowel to rotate around its mesenteric pivot point.

6. The Mechanical "End-Game"

When the internal pressure is high enough to displace the diaphragm, compress the heart, and stun the gut, the system is at its limit.

This is the stage where the buoyancy-induced torque becomes most dangerous.

With the colon already stretched and filled with air, the slightest movement can initiate the rotation that leads to a torsion event.

At this point, the "kink in the hose" is not just blocking air—it is trapping a high-pressure, systemic stressor that is actively pushing against the patient's respiratory, cardiac, and digestive functions.

Disclaimer:

This explanation is for educational purposes regarding the mechanics of gastrointestinal pressure and does not replace medical advice.

I am not a medic, but a qualified chartered chemist (Fellow Royal Society of Chemistry) who had worked with pressurised gas and liquids for over 25 years - above is my own interpretation of what is happening.

If you are experiencing respiratory distress, heart palpitations, severe abdominal pain, or are unable to pass gas or stool, please treat seek immediate care.