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NON-ACID REFLUX for PND ?

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deebo
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NON-ACID REFLUX for PND ?

Post by deebo »

Heard this on BBC about "NON acid relfux" as 1 possible cause for what some think is post nasal drip ,and throat clearing .
Have a listen http://www.bbc.co.uk/programmes/b01mqpgy

transcripts below : VV
First up is an annoying need to constantly clear the throat. Ros has a niggling dry cough and often feels there is mucus stuck at the back of her throat. And another listener, who has asked to remain anonymous, lives with someone who constantly clears theirs.
They have been told it could be something called post nasal drip, but Professor Alyn Morice, one of the UK's leading experts on cough, thinks there could be another explanation.

Morice
The patient themselves often doesn't actually realise that they're doing it, it becomes a habit but it's not a habit as such, it's actually a response to an irritation which becomes repetitive and frequently I have in my clinic patients sitting there calmly, whereas the relative is saying if you don't cure her throat clearing or cough I'm going to kill her.

Porter
We have them in our waiting room too.

Morice
Absolutely, very common problem and a common fantasy is that it is post nasal drip and there's stuff dripping down the back of the nose. In fact when people have looked at the amount of dripping that occurs it's not really related at all to what the symptoms are. My own opinion is that almost all of these people have non-acid reflux, that's stuff coming out of the stomach, coming up and irritating the back of the throat, it's not acid so it doesn't give you heartburn but it gives you either coughing, which is what I major on but also the throat clearing and so one of our questions on our questionnaire we ask everybody coming to the clinic is about throat clearing and frequently it's the major symptom that they've got apart from the coughing.

Porter
Is there a particular time when it's worse or if you have a....

Morice
Yeah certain things set it off. So stress will set it off - I gave a little cough there and a throat clear...

Porter
Beautifully demonstrated.

Morice
Absolutely, well here I am stressed by the environment here. But no stress is one thing. Eating and after meals particularly, so you've finished eating and then the valve is told to open at the top of the stomach to allow the gas to escape and that sets it off. Talking, so is singing, laughing, that sort of thing, waggles the valve and allows the stuff to come up and that sets you off.

Porter
You say this is non-acid reflux but the stomach contents are highly acid and there's a valve...

Morice
No, no, no that's a common fallacy, they are just before a meal, so when you're about to eat the acid has been produced and you're ready to digest but once you've had the meal food neutralises the acid, so for two or three hours after a meal your stomach is pretty neutral and that's when the gas and the mist that comes up is being produced.

Porter
So this mist that comes up - you can imagine the mist escaping through the valve at the top of the stomach - if it's not acidic what is it in it that irritates the lining?

Morice
Well it's a mixture of partly digested food protein and all the stuff that you eat, it's sort of like...

Porter
It's not pleasant?

Morice
Not pleasant, it's like nebulised vomit I tell people and you can imagine how unpleasant that is. But it happens to us all, we all taste our food in the back of our throats sometimes and all I'm saying is that that's the sort of thing that we experience and these people have irritated their nerves in the upper airways, the throat, and they're very sensitive to it.

Porter
And the nerves are just doing their job, because they're there that if something was irritating it, if there was a foreign body or something, the whole idea is that you do clear your throat and cough.

Morice
Absolutely, absolutely but they have become super-sensitive, they have a hypersensitivity, so even a small amount of irritation which in a normal person would not precipitate a throat clear, they are having this repetitively occur.

Porter
How do you manage it?

Morice
How do I manage it? Well there are some very simple drugs which we can try and I don't give it to them on a permanent basis but we do it as, what's called, therapeutic trials. So I give them a prescription for metoclopramide, which is probably the commonest anti-sickness tablet in the world, and we try it - one tablet three times a day - and if it improves things well that's the diagnosis.

Porter
And that works by?

Morice
It tightens the valve up and also improves the movement so that things are going downwards as opposed to coming back upwards.

Porter
You see I think in general practice land we may be a bit behind the times here because with a story like that the first thing we would probably do is try something to suppress the acid production - proton pump inhibitors - omeprazole and rabeprazole, drugs like that. But what you're saying is it's not necessarily the acid - so it's not a good form of attack.

Morice
That's likely to make it worse if anything, right? I only give those drugs when people have a lot of heartburn. Actually our study shows that if you've got that syndrome of non-acid reflux giving the drugs may actually make things worse, particularly it may predispose you to inhale things and you'll get more wheezing and breathlessness because of your inhaling it, it'll go down the wrong way and the acid there is to protect by irritating and causing you to cough it out.

Porter
So avoid the acid agents unless heartburn's present, try metoclopramide, if that doesn't work is there any...?

Morice
Well there's one you can get over-the-counter of course - domperidone. A daughter of a colleague last week was cured by it, much to the surprise of the paediatrician she was under.

Porter
Over-the-counter.

Morice
Exactly, I said look just try this and they went away and tried it and having had cough and breathless and throat clearing for several months and it was better.

Porter
Going back to our listener, in a case like this that might have gone - we don't know how long but it sounds like probably years, if they were to try the therapy it would still work after all this time?

Morice
Yeah our record is 66 years and she got better and I got a very nice letter saying her life had been transformed. The problem is that we don't have very good drugs for it so those drugs that I've mentioned perhaps work in a third of people. So we have four or five different drugs and we just try them in rotation around.

Porter
But the good news is I mean it's certainly - on that classic story it's something that a GP could start very easily, this therapeutic trial - use one drug and then another one and if it's still not working then seek expert help from someone like you.

Morice
Absolutely, well my own GPs are now experts and I just get all the difficult ones I'm afraid.

Porter
Professor Alyn Morice talking to me at his clinic in Castle Hill Hospital near Hull.

:!:


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mike987
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Post by mike987 »

How do we get started on this.

The second drug mentioned is sometimes used to increase lactation in women. Should I be afraid of that. I want to be cured so bad. Anyone have ideas?

Is Metoclopramide/Reglan in the US, available without prescription? I'm in Japan.


Thank you for posting this, deebo. I hope it leads to something useful.
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deebo
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Post by deebo »

all great questions Mike . Could you ask your Docs in JP about this condition ? I find we are constantly informing our medical professionals of new stuff and 'non-acid reflex' isn't "Curezone" quackery .

Emailing the UK Doc Morice in the podcast isn't out of the question . I'll have another listen to the podcast tonight at work but I think they did mention some over the counter fixes ,which if so you could buy in JP or online If you wanted
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Post by mike987 »

For a condition like this, or where PND is present... Is this the area that stinks?

Before I've referred to mucus feeling as though it's in my lungs, but I think this may be the area.. deceptively just behind the epiglottis is this huge area around the voice box, that seems like it could easily be filled with stinking, immobile mucus.


http://youtu.be/iYpDwhpILkQ


Seeing this has helped me understand this feeling in my throat.. In fact, I can feel it there right now. There is stubborn mucus.. This just shy or a shortness of breath feeling, that leaves me clearing my throat and grunting almost constantly, in an effort to clear the mucus.

Whether the mucus is caused by irritation in the larynx/sinuses due to the condition described above, or if it's simply excess mucus from the sinuses draining down.... Either way, the mucus seems like it could settle there quit easily, as being particularly thick, it doesn't go down the throat, but just sticks there, perhaps rotting with bacteria.. normal nose breathing won't disturb the mucus and send them airborne as much as talking, humming, singing, etc, would as you can see from the vibration of the voice controlling muscles....

I've had an endoscopy of the stomach, but I don't think they bothered investigating this area, and I never had the above test done before.

http://youtu.be/zQjJ5Alx40g

This video discusses how voice is produced... and maybe will help you hypothesize how BB could be emanating from this region..



How do you post youtube videos? I seem to forget. For now, sorry, you'll have to copy and paste the youtube address in the address bar. I'd prefer to have it available straight away in the post though.
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Post by halitosisux »

Mike, replying from the other thread mentioning about thick mucus being produced in the throat itself.
It seems like the area near the vocal chords are areas where mucus could stagnate and smell. But can it really do that? Even when you have a bad chest infection, and the mucus is coming from the lungs and windpipe, and coughed out past the vocal chords, the slightest sensation of mucus pooling up there would cause the choking/coughing reflex and air gets exhaled at very high speed, dislogding everything. And once dislodged, any mucus that replaces it would need enough stagnation time before it begins to smell. Something that's only likely to happen while you're sleeping.

Mucous membranes also have cilia which sweep mucus along, so even mucus which doesn't get blown away by a cough or sneeze, would still get swept along.

Maybe these cilia are faulty in some people? Smoking and alcohol paralyzes them - that's what causes smokers cough. But smoking doesn't necessarily cause anything except for breath that smells like an ashtray for most people.

I think it's a possibility, but not a very likely one. Odours from the tongue or the tonsils or foul mucus drainage from the nasal cavity, stomach reflux, would all give the sensation of a foul tasting throat. But that's all.

One thing that might cause the type of breath symptoms you describe would be pouches can form in the esophagus, like zenker's diverticulum. I think there's different kinds of pouches that can form where debris, bacteria and food etc can become trapped and smell, constantly or intermittently. The throat, the trachea or the esophagus are all areas where this kind of pouch could form. I don't know what kind of diagnostics would be used to find such abnormalities, because I can clearly remember my endoscopy, and the tube literally being rammed down my esophagus. There's no way anyone inspected my esophagus, let alone my throat or trachea. So just by having an endoscopy doesn't rule these out. Possibly a CT scan or specialized chest x-ray is required?
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Post by mike987 »

Is the mucus coming from the lungs? Are we sure of that? That's what I always assumed, when I'd wake up and cough out some thick mucus, but being aware of that space, it feels like it's resting around that vocal cord area. Humming out slowly, I can feel and hear it.. Upon touching the region on the outside of the throat, I can feel the vibrations interrupted lightly by mucus.

It's not a ton of mucus, but I suspect that this kind of thick mucus, perhaps created by some form of reflux, covers the bacteria like a blanket, and the vibrations of the vocal region are what rustle up the bacteria and release the odors.

I'd certainly liked to have a thorough exam of the region.
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Post by halitosisux »

Some mucus will undoubtedly come from the lungs and the airways leading to them. It's hard to know, once you become aware of something, whether it's normal or abnormal. The throat is supposed to have a layer of mucus there. But at what point does something that everyone have become so abnormal that it causes bad breath?

Really bad coughs and tons of mucus from allergies or asthma or colds etc, don't necessarily mean a person ends up with bad breath. And mucus itself contains antibacterial enzymes.
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Post by deebo »

Mike . fixed the youtube links . Do you sometimes get hoarseness ?Like scratchy voice and can't produce low bass sounds at times ? Have you tried expectorants or hot steam and things that helped ?
For me ,i've been prescribed various throat sprays, nose sprays, pills ,nasal rinses ,diet advices ,rubs.. etc . They have often been rather helpful in subduing my throat clearing ,"PND" and things ,all while still getting convincing reactions due to my breath still kickin' strong.

Hali ,Zinker's is something that Doolittle really recommended I check for. Since my mid 20s at times I'd have throat pain when drinking too fast ! Just another thing to check off the list . Although at this time its likely to be a systemic issue ,being that I had marked BO growing up at got teased about it . Who know though

I know when I have hard phlegm ,I just can't seem to swallow it .(gross,I know) it has to be spit out . A hot drink while in a hot shower can help loosen the grime for me
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Post by stinkycheeseman »

I have always had mucus to spit up since I was young nasty thick green mucus. I also feel like theres a whole bunch crap In my lungs.
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Post by rmb »

one filipino guy scrapes his tongue with inverted spoon up to the throat and he claimed that he is now free from halitosis.i do the same thing and i think its works at least temporarily.i noticed that anybody who comes close to me dont react anymore whenever i do this. but after hours im stinking again.i think the greenish mucus stacked in our throat is the source of bad breath and i have that.i swear it works after weeks of observation.
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