Bad Breath Halitosis Forum

Esophagopharyngeal reflux (EPR) is the regurgitation of esophageal contents back into the larynx and pharynx. Gastroesophageal reflux disease (GERD) is the disorder caused by the regurgitation of GASTRIC contents into the esophagus. The hallmark of GERD is heartburn. LPR is the disorder caused by the regurgitation of GASTRIC contents into the larynx and pharynx. Persons with GERD and LPR usually respond well to medications that reduce the acid content of the refluxed materials (H2-blockers/proton pump inhibitors). Patients with EPR present with symptoms very similar to persons with LPR. They do not, however, respond well to traditional anti-reflux therapy. The problem with EPR is that of bolus transport and esophageal emptying. Most patients with EPR have a disorder of esophageal motility. Some of the ingested food sticks in the esophagus and regurgitates back into the throat causing throat clearing, cough, excessive mucus, etc... Treatments for EPR are similar to treatments for esophageal dysmotility. Treatment for EPR is often less successful than treatmment for LPR or GERD. Medications that reduce the acid content (H2-blockers/PPIs) do not stop static esophageal contents from being regurgitated back into the upper airway. Behavioral modifications are crucial and alginates (Gaviscon) have shown some success in keeping the food contents from regurgitating out of the esophagus. persons with a diagnosis of LPR who fail medical therapy should be considered for a diagnosis of EPR. A dynamic video-fluoroscopic swallow evaluation and ambulatory impedance testing are the only ways to diagnosis EPR.

Although they show no apparent lack of hygiene or obvious medical symptoms, most people with the disorder report having foul body odors, bad breath, or a bad taste in their mouths. Studies in the last few years have shown that trimethylaminuria results from defects in an enzyme that breaks down trimethylamine, a byproduct of protein digestion released by bacteria living in the gut. This small molecule — the compound that gives fish their fishy odor — smells foul or garbage-like at low concentrations and fishy in larger amounts.

People with the disorder can release trimethylamine through breath, sweat, and urine. A few have a strong odor all the time, but most others experience a less severe smell that fluctuates over time. Researchers speculate that the variability of symptoms indicates that a range of genetic mutations can cause the disease and that stress and diet play a role in triggering symptoms