Is My Bad Breath Linked to Gastrointestinal Issues?

Q: Is My Bad Breath Linked to Gastrointestinal Issues?

Hello： Bad breath is not absolutely related to bacteria or Helicobacter pylori, so there is no need for antibiotics. <br>If you have already consulted with traditional Chinese medicine, dentistry, otolaryngology, and gastroenterology, there is no need to worry too much. <br>You s

Is my bad breath coming from my gastrointestinal tract?

This is a lengthy narrative about my battle against bad breath, and I hope you will listen to my story.
I have visited traditional Chinese medicine practitioners, dentists, otolaryngologists, and gastroenterologists, but none have identified any issues.
Many years ago, I became aware of the unpleasant odor in my mouth.
I often felt dry mouth, and no matter how much water I drank, it did not help.
Whenever I touched the back of my tongue and smelled it, I felt as if I had eaten garbage for dinner; it had a sour taste.
After learning that Helicobacter pylori could potentially cause bad breath, I began to suspect that I might be infected with this bacterium and decided to investigate this possibility.
Three years ago, I underwent a carbon-13 breath test, and the results were negative.
Just as I was in shock and decided to look for the next possibility, I had an endoscopy, and the biopsy results were positive.
However, after reading various resources, I decided to set this issue aside for the time being.
Fast forward to February of this year, I had had enough and decided not to endure this nauseating smell any longer.
I went to a clinic and informed the doctor that I had previously been diagnosed with Helicobacter pylori and hoped to have another endoscopy for confirmation.
On the same day as the endoscopy, the doctor said, "Your stomach is a bit inflamed, and you have some gastroesophageal reflux." He then prescribed antibiotics, saying, "I'll give you the medication to eradicate the bacteria since you had it before, and it seems you still have it.
You can take this home." I thought to myself, "Is this really okay? We haven't even confirmed it yet!" With a sense of apprehension, I took my medication home: "Amoxicillin 500 mg" *2, "Omeprazole 30 mg," "Clarithromycin 500 mg," and "Pantoprazole 40 mg," to be taken twice a day for a week.
Unbeknownst to me, that week turned out to be one of the happiest weeks of my life.
My breath was fresh, and I no longer experienced dry mouth.
When I touched the back of my tongue, I was amazed at the fresh breath.
I thought I had finally rid myself of the annoying Helicobacter pylori, and my life was about to begin.
However, on the day of my follow-up appointment, the doctor told me, "Your test results are negative." I was so shocked that I couldn't comprehend it.
So who was causing the problem?
For the next month, the doctor only prescribed me PPIs: "Omeprazole 30 mg" for two weeks at 1 per day, and "Pantoprazole 40 mg" for two weeks at 1 per day.
Naturally, that unpleasant taste returned to my mouth.

I have a few questions:
1.
Since the antibiotics were effective, could the cause of my bad breath be related to the indications of these four medications?
2.
Given that I only took acid reducers in the following weeks, does this mean that the cause of my bad breath is not due to excessive stomach acid or gastroesophageal reflux?
3.
I hope the doctor can provide me with advice on where to start my treatment.
Thank you, doctor, for taking the time to read about this journey.
To Be Continued...

K, 20~29 year old female. Ask Date: 2020/03/21

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Bad breath is not absolutely related to bacteria or Helicobacter pylori, so there is no need for antibiotics.
If you have already consulted with traditional Chinese medicine, dentistry, otolaryngology, and gastroenterology, there is no need to worry too much.
You should pay attention to oral hygiene by brushing your teeth and rinsing your mouth after eating, in the morning, or before bedtime, and also make sure to clean your tongue.
Avoid eating late-night snacks to prevent the fermentation smell of food in your mouth.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2020/03/21

More Info

Bad breath, or halitosis, can indeed be linked to gastrointestinal issues, particularly when it involves the stomach and esophagus. Your experience highlights a complex interplay between oral health and gastrointestinal function, which can often lead to confusion and frustration when seeking a resolution.

1. Connection Between Bad Breath and Gastrointestinal Issues: Bad breath can arise from various sources, including poor oral hygiene, dry mouth, and gastrointestinal problems. In your case, the presence of Helicobacter pylori (H. pylori) is significant. This bacterium is known to cause stomach inflammation and ulcers, and it can also contribute to bad breath. When the stomach is inflamed or when there is acid reflux, the contents of the stomach can rise into the esophagus and even into the mouth, leading to an unpleasant odor. Your initial treatment with antibiotics and proton pump inhibitors (PPIs) likely reduced the bacterial load and improved your symptoms temporarily, which is why you experienced a week of fresh breath.

2. Understanding the Role of Medications: The medications you were prescribed, including antibiotics and PPIs, are designed to target H. pylori and reduce stomach acid production. The fact that your breath improved while on these medications suggests that the underlying issue may indeed be related to the presence of H. pylori or the effects of acid reflux. However, the subsequent return of bad breath after stopping the antibiotics indicates that the root cause may not have been fully addressed. It’s essential to understand that while PPIs can help manage symptoms of acid reflux, they do not eliminate the underlying cause of bad breath if it is related to gastrointestinal issues.

3. Next Steps for Treatment: Given your situation, it would be prudent to consider a few steps moving forward:
- Follow-Up Testing: Since your breath improved with antibiotics but returned after stopping them, it may be beneficial to retest for H. pylori. A breath test or endoscopy with biopsy can confirm its presence or absence.

- Dietary Modifications: Consider keeping a food diary to identify any specific foods that may exacerbate your symptoms. Foods high in sugar, certain spices, and dairy can contribute to bad breath and gastrointestinal discomfort.

- Hydration and Oral Hygiene: Ensure you are drinking enough water to combat dry mouth, which can worsen bad breath. Maintaining good oral hygiene, including regular brushing and flossing, is crucial. Consider using a tongue scraper to remove bacteria that can accumulate on the tongue.

- Consult a Specialist: If your symptoms persist, it may be beneficial to consult a gastroenterologist for a thorough evaluation. They can assess for conditions such as gastroesophageal reflux disease (GERD) or other gastrointestinal disorders that may be contributing to your symptoms.

4. Psychological Factors: Anxiety and stress can also exacerbate gastrointestinal issues and contribute to bad breath. If you find that anxiety is a significant part of your experience, consider speaking with a mental health professional who can help you develop coping strategies.

In conclusion, while your bad breath may be linked to gastrointestinal issues, particularly H. pylori infection and acid reflux, it is essential to continue working with healthcare professionals to identify the underlying cause. By addressing both the gastrointestinal and oral health aspects, you can work towards a more comprehensive solution to your symptoms.

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