Chronic GERD: Causes of Bad Breath and Throat Pain - Gastroenterology and Hepatology

Long-term gastroesophageal reflux disease (GERD) has been present for a long time?

Hello doctor, I have very severe halitosis that has become so bad that even when others wear masks, they can still smell it.
This has significantly affected my life.
I also have severe gastroesophageal reflux disease (GERD) and I am taking medication to manage it; however, when I take the medication, it improves a bit, but when I don’t, it gets much worse.
Additionally, my throat has been inflamed for a long time and it feels like it never gets better; it is painful and burning every day.
I have been controlling my diet and have avoided coffee, spicy foods, and other irritants, but there has been no improvement.
I would like to know if these symptoms could be caused by a loose lower esophageal sphincter.
I have persistent halitosis 24/7, including foul breath even when I breathe.
I brush my teeth daily and use mouthwash, and I do not have cavities, so I really cannot find the cause of the bad breath.
After eating, I often feel like the taste of food rises up, especially when I burp, which frequently causes me to choke on the food that comes back up.
It is quite uncomfortable.
Could this be caused by an esophageal diverticulum or a hernia? I would like to ask for your opinion.

yi, 20~29 year old female. Ask Date: 2021/01/24

Dr. Zhang Kebin reply Gastroenterology and Hepatology

Dear Miss,
Regarding your inquiry about long-term severe gastroesophageal reflux disease (GERD), it is noted that your symptoms improve with medication.
I recommend discussing long-term medication management with your primary physician.
If you are experiencing issues with being overweight, weight loss may help alleviate your symptoms.

You also questioned whether your gastroesophageal reflux is caused by the formation of esophageal diverticula or a hiatal hernia.
Generally, it can be attributed to several factors: relaxation of the lower esophageal sphincter, increased abdominal pressure, or esophageal sensitivity.
To gain a clearer understanding, you may want to consult your primary physician to see if a 24-hour pH monitoring study or esophageal manometry is necessary to clarify the underlying cause.

Wishing you good health!

Reply Date: 2021/01/24

More Info

Chronic gastroesophageal reflux disease (GERD) can lead to a variety of symptoms, including bad breath (halitosis) and throat pain. Your description of severe bad breath, which persists even with good oral hygiene practices, and the ongoing throat discomfort suggests that your GERD may not be adequately controlled.
GERD occurs when stomach acid frequently flows back into the esophagus, leading to irritation and inflammation. This reflux can cause a range of symptoms, including heartburn, regurgitation, and in your case, bad breath and throat pain. The bad breath can be attributed to several factors associated with GERD:
1. Acid Reflux: When stomach contents, including acid, flow back into the esophagus, they can carry with them food particles and bacteria, which can contribute to foul-smelling breath.

2. Esophageal Inflammation: Chronic exposure to stomach acid can lead to inflammation of the esophagus (esophagitis), which may also contribute to a sensation of pain in the throat and could potentially lead to bad breath.

3. Dry Mouth: GERD can sometimes lead to dry mouth, either due to medications used to treat it or as a result of the condition itself. Saliva plays a crucial role in washing away food particles and bacteria, so a decrease in saliva can lead to an increase in bad breath.

4. Dietary Factors: Although you mentioned that you have been controlling your diet by avoiding coffee, spicy foods, and other irritants, it's important to note that certain foods can still exacerbate GERD symptoms. Foods high in fat, citrus fruits, and chocolate are common culprits that can worsen reflux.

5. Underlying Conditions: Conditions such as a hiatal hernia or esophageal diverticula can also contribute to GERD symptoms and may lead to complications like bad breath. A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity, which can exacerbate reflux symptoms.

Given your symptoms, it is crucial to address the underlying causes of your GERD. Here are some recommendations:
- Medication Review: Since you mentioned that your symptoms improve with medication, it may be beneficial to consult with your healthcare provider about optimizing your GERD treatment. This could include adjusting the dosage or trying a different class of medications, such as proton pump inhibitors (PPIs) or H2 blockers.

- Lifestyle Modifications: In addition to dietary changes, consider other lifestyle modifications such as eating smaller, more frequent meals, avoiding lying down immediately after eating, and elevating the head of your bed to reduce nighttime reflux.

- Throat Care: For your throat pain, consider using throat lozenges or gargling with warm salt water to soothe inflammation. Staying hydrated can also help alleviate some discomfort.

- Dental Check-Up: Although you mentioned good oral hygiene, it may be worthwhile to consult with a dentist to rule out any dental issues that could be contributing to bad breath.

- Further Evaluation: If your symptoms persist despite these measures, further evaluation may be warranted. This could include an endoscopy to assess the condition of your esophagus and stomach, as well as to check for any structural abnormalities like diverticula or a hiatal hernia.

In summary, your symptoms of bad breath and throat pain are likely related to your chronic GERD. By working closely with your healthcare provider to optimize your treatment and making necessary lifestyle changes, you can improve your symptoms and overall quality of life.

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