Bad breath, a silent symptom of GERD


If regular brushing, flossing and popping innumerable breath mints does not work for bad breath, it is time to realise that the problem is deeper and beyond the mouth. GERD has a definite link to bad breath which is a rather embarrassing problem, causes for which sometimes can be medical.

Gastroesophageal reflux disease, better known as GERD is a chronic digestive disease that occurs when the acids of the stomach generally flow back into the food pipe or esophagus, this reaction irritates the esophagus hence causing GERD. The acid moving back into the esophagus may cause a burning sensation, discomfort and tissue damage. With reflux, an enzyme called ‘pepsin’ enters the throat which causes unpleasant breath.

Studies show that over 30% of the UAE population suffers from acid reflux with various studies revealing that there is 15-40% prevalence of GERD among various populations. Although this could be misjudged because a lot of times GERD may be asymptomatic in some patients and may present atypical symptoms in others. The condition generally affects people over the age of 60 but the number of people of different ages affected by the disease is on the rise both locally and globally. The burden of the disease is enormous, affecting the quality of life, physical, emotional and social well-being of patients.

Despite the high prevalence of GERD, there is the serious lack of awareness about the condition among the population. People are generally less aware of GERD when it presents with atypical symptoms.

GERD has a number of reasons to its cause. Modern lifestyles leading to high levels of stress, extremely high consumption of rich and fatty foods and lack of any physical activity are few of the lifestyle factors that make people susceptible to GERD.

GERD is caused when the esophagus becomes weak or relaxes when it shouldn’t, hence causing the contents of the stomach to rise up. Weakening or relaxation of the esophagus is caused due to increased pressure on the abdomen from being obese/ overweight, certain medications may cause the same to happen or smoking could be the cause. Hiatal Hernia is a condition which a part of the stomach pushes upward through the diaphragm. The diaphragm originally has a small opening through which the food pipe is connected to the stomach. This condition cause the stomach to move up into the chest, hence making the natural anti-reflux mechanism weak or incompetent.

Healthy adults may experience GERD either as heartburn or acid regurgitation or it may even go unnoticed, being asymptomatic.

GERD may cause a number of symptoms like burning sensation in the chest or throat or frequent heartburn, sore throat, bitter taste in the mouth, coarse voice, persistent cough, difficulty in swallowing, nausea, bloating etc.

Foul smelling breath, respiratory problems, vomiting, wearing away of teeth etc are other symptoms that are caused by GERD.

Certain lifestyle changes like maintaining an optimum weight, avoiding foods that trigger heart burn, eating smaller portions of meals, quitting smoking etc. may help reduce the incidence of heartburn.

Effective medicines for treating GERD are available, and most patients can be managed well with simply a couple of pills a day. A small percentage of patients will have severe/refractory reflux. Some of these patients might even develop complications like scarring/stricture of the food pipe, or a more sinister change called Barrett’s esophagus. Patients who are inadequately controlled with medicines or who cannot take these pills for whatever reason have the option to be treated with a surgery that attempts to correct the junction between the esophagus and the stomach.

There are no alternative medicines or therapies for the treatment and prevention of GERD. Lifestyle changes are advisable to reduce the risk of any disease including GERD. Medicine and alternative therapies may provide relief but surgery is the ultimate cure for GERD.

 

Dr. Amal Premchandra Upadhyay

Consultant in Gastroenterology

Aster Hopsital, Mankhool.

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