Reflux & Halitosis

  It was my symptom of constant bad breath that led me to a dentist, who led me to a doctor, which led to a diagnosis of Barrett's esophogus. My oral health is great, according to my dentist, but I still have bad breath, which I figure must be related to reflux. Besides using a toothpaste and mouthwash containing chlorine dioxide, and tongue scraping and gum chewing... is there anything I can do to battle this? It's socially embarrassing - help is appreciated. Thanks!
  --PJ
Dear PJ,
Halitosis can be a manifestation of chronic gastroesophageal reflux disease. It is important to review the medications you are taking and your current diet in addition to meticulous oral hygeine. Chronic lung disease, liver failure, uremia (kidney failure) and diabetic ketoacidosis can all be associated with bad breath. If your bad breath is mostly secondary to gastroesophageal reflux it should respond to medical therapy with histamine receptor antagonists (such as ranitidine) or proton pump inhibitors (such as omeperazole). It is also important to adhere to anti-reflux measures.
The lifestyle modifications that are considered helpful in patients with hiatal hernia and gastroesophageal reflux are called anti-reflux measures. Foods that can decrease lower esophageal sphincter pressure should be avoided. Those foods include: coffee, tea, cola beverages (with and without caffeine), citrus drinks, fatty foods, spicy foods, onions, peppermint and chocolate. Medications such as aspirin or non-steroidal inflammatory agents (for example: ibuprofen, naproxen etc.) can be irritating to the stomach or esophagus. Other medications that decrease lower esophageal sphincter pressure are theophylline and albuterol (medicine for asthma) and calcium channel blockers (such as dilitiazem, nifedipine for high blood pressure and angina). It is important for you to review the list of your medications with your doctor. Other helpful lifestyle changes include: elevating the head of your bed on 4-6 inch cinderblocks or using a wedge under the mattress; not eating at least 3-4 hours before bedtime; eating smaller, more frequent meals and avoiding smoking and alcohol. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
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