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When refluxed stomach acid touches the lining of the esophagus, it causes the sensation of heartburn in the chest or throat. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Leakage due to GERD can result in acid reflux and bad breath. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.
Anyone, including infants, children, and pregnant women, can have GERD.
The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat, or like you are choking, or your throat is tight. GERD can also cause a dry cough from the associated acid reflux and bad breath to go along with it..
Studies show that GERD is common and may be overlooked in infants and children. It's possible for acid reflux and bad breath due to reflux to be present in babies and very young children. It can cause repeated vomiting, coughing, and other respiratory problems. Children's immature digestive systems are usually to blame, and most infants grow out of GERD by the time they are 1 year old. Still, you should talk to your child's doctor if the problem occurs regularly and causes discomfort. Your doctor may recommend simple strategies for avoiding reflux, like burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, the doctor may recommend avoiding certain foods.
Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that the child sleep with head raised. If these changes do not work, the doctor may prescribe medicine for your child. In rare cases, a child may need surgery.
No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid reflux and bad breath due to reflux to occur. A hiatal hernia can occur in people of any age; many otherwise healthy people over 50 have a small one.
Other factors that may contribute to GERD include:
- alcohol use
- obesity
- pregnancy
- smoking
Also, certain foods may trigger reflux events, such as:
- citrus fruits
- chocolate
- drinks with caffeine
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, like spaghetti sauce, chili, and pizza
If you have had heartburn or any of the other symptoms, such as acid reflux and bad breath, for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.
Suggestions for Lifestyle Changes
If you smoke, stop.
Do not drink alcohol.
Lose weight if needed.
Eat small meals.
Wear loose-fitting clothes.
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts — just using extra pillows will not help.
Medications for GERD, Acid Reflux and Bad Breath
Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium, but they can cause constipation as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.
H2 blockers, such as Tagamet HB, Pepcid AC, Axid AR, and Zantac 75, impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms.
Proton pump inhibitors include Prilosec, Prevacid, Protonix, Aciphex, and Nexium, which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD.
I've used several of these and now take Protonix every day. To say it works great, would be an understatement. If you're having problems with acid reflux and bad breath, please talk to your doctor about getting on a proton pump inhibitor.
Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.
Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.
What if symptoms persist?
If your acid reflux and bad breath do not improve with lifestyle changes and/or medication, you may need additional tests for the digestive tract, such as:
A barium-swallow x-ray to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus.
An Upper Endoscopy, which is more accurate than a barium-swallow x-ray, may be performed in a hospital or a doctor's office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus, to search for abnormalities, and to remove tissue samples for biopsy.
In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus.
If your treatment resolves your acid reflux but bad breath remains unchanged, you may need to treat the symptoms separately. Make sure you have a good oral hygiene routine in place. Read
Fourteen Guidelines To Help Prevent Bad Breath.
Surgery
Surgery may be indicated when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
Recently the FDA approved an implant that may help people with GERD who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.
What are the long-term complications of GERD?
Sometimes GERD can cause serious complications. Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.
Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.
For information about Barrett's esophagus, please see the Barrett's Esophagus fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases.
Points to Remember About GERD, Acid Reflux and Bad Breath
Heartburn, also called acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD. Acid reflux and bad breath together may also indicate the presence of GERD.
You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, or pain in the chest.
In infants and children, GERD may cause repeated vomiting, coughing, and other respiratory problems. Most babies grow out of GERD by their first birthday. It's possible for both infants and children to have acid reflux and bad breath that goes with it.
If you have been using antacids for more than 2 weeks, it is time to see a doctor.
Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.
For More Information On GERD, Acid Reflux and Bad Breath
American College of Gastroenterology (ACG)
4900-B South 31st Street
Arlington, VA 22206–1656
Phone: 703–820–7400
Fax: 703–931–4520
Internet: www.acg.gi.org
American Gastroenterological Association (AGA)
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–652–3890
Email: webinfo@gastro.org
Internet: www.gastro.org
International Foundation for Functional Gastrointestinal Disorders (IFFGD) Inc.
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.aboutgerd.org
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3939
Email: naspghan@naspghan.org
Internet: www.naspghan.org
Pediatric/Adolescent Gastroesophageal Reflux Association Inc. (PAGER)
P.O. Box 1153
Germantown, MD 20875–1153
Phone: 301–601–9541
Email: gergroup@aol.com
Internet: www.reflux.org
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