This has been going on for almost a year. We have had monitoring of his throat for acid reflux, and he did have some, but the rise in acid doesn’t seem to correspond with the gagging, and medication doesn’t make a difference. He has tried over-the-counter medications as well as prescriptions. He has also had an endoscopic procedure, which showed no polyps.

I would greatly appreciate any information you can provide; our doctors seem to be at a dead end.

DEAR READER: Spontaneous gagging can be a symptom of several disorders; therefore, I cannot provide a definitive answer. I believe your husband’s best chance at getting a diagnosis is to be examined and tested by a gastroenterologist (if he hasn’t done so already) or by getting another opinion from a second gastroenterologist (preferably one unaffiliated with the first) or an ear-nose-and-throat specialist.

The most likely cause is GERD. Gastroesophageal reflux disease is a common condition in which acid backwashes into the throat. Reflux, either chronic or occasional, can be the result of excess acid production; a weak or improperly functioning hiatus (the ring of muscle that connects the esophagus and stomach); hiatal hernia (in which a portion of the stomach slides into the esophagus or alongside it in the chest cavity); diet/lifestyle; etc.

Symptoms can include a burning sensation within the chest, a sour taste in the mouth, dry cough, regurgitation of food or liquids (which may result in gagging), sore throat, chest pain, difficulty swallowing (which may cause gagging) and more. People with reflux do not always experience symptoms, and for some, symptoms may appear unrelated.

Just because your husband’s gagging does not appear to be related to the acid reflux doesn’t mean that it isn’t. I suggest your husband make some moderate lifestyle changes to see whether his symptoms improve. He should exercise on a regular basis; avoid fatty, greasy and acidic foods; and consume more whole grains, fruits and vegetables. He may also wish to use over-the-counter or prescription medication daily to try to prevent symptoms.

Other possibilities include vagus-nerve impingement, esophageal spasms, smoking and achalasia.
Achalasia is rare, occurring in about one in 100,000 people, so this is not likely the problem. It causes regurgitation and difficulty swallowing, both of which can result in gagging.

Esophageal spasms are abnormal muscle contractions within the throat that typically causes pain and difficulty swallowing.

Vagus-nerve impingement can cause nausea, vomiting, gagging and more, but it is most common in people who have had sinus surgery or head injury.

Smoking is another common cause of gagging that is often overlooked. Smokers, especially heavy smokers, are damaging their lungs with the habit, and as the damage progresses, excess fluid and mucus can accumulate in the lungs and drip down the back of the throat. This situation can cause difficulty breathing, coughing, a choking sensation and gagging until the mucus can be expelled.

To provide related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter, and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Gastroesophageal reflux disease occurs when the muscle that separates the stomach from the esophagus fails to close properly or is weakened, allowing a backwash of stomach acid into the esophagus. Hiatal hernia occurs as a result of increased abdominal pressure caused by sudden physical exertion, vomiting, coughing, obesity, increased abdominal pressure and excess fluid in the abdomen.

A small 2002 study of 18 women over the age of 65 reported the concomitant use of omeprazole with calcium carbonate when taken without food decreased calcium absorption in elderly women. It contradicted a study a few years earlier from Tufts in which omeprazole was found not to interfere with calcium, zinc or phosphorous absorption.

The medication your physician recommended is to reduce the amount of acid produced. Common symptoms of GERD include chest, neck and arm pain, breathing difficulties, dry cough, difficulty swallowing, burning or pressure and bad breath. Debilitating stomach cramps and vomiting are uncommon. Speak with your physician to rule out other possible causes or health conditions and to determine whether you should continue or discontinue the omeprazole. Then request a referral to a gastroenterologist for further testing if appropriate.

To provide related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux & Indigestion.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Gastroesophageal reflux disease is acid reflux that occurs regularly. The ring of muscles that separates the stomach from the esophagus is either weak or fails to close properly. Symptoms present when the backwash of stomach acid enters the esophagus and, as you are likely aware, can include difficulty swallowing, chest pain, a burning sensation, pain, dry cough, bad breath and more.

Treatment is one of progression. Over-the-counter medications such as Prilosec, Tagamet or Pepcid AC might be considered; when ineffective, they may be followed by prescription medication. Then might come X-ray testing, such as a barium swallow or upper endoscopy, which should reveal whether your symptoms are from GERD or caused by something else. If your GERD is severe and caused by a hiatal hernia, surgical repair may be recommended. Hiatal hernias can develop from sudden physical exertion, straining during evacuation, vomiting or coughing.

Other than the modifications you have already tried, I might suggest weight loss and discontinuing smoking if you are overweight or smoke, eating several smaller meals throughout the day, wearing loose-fitting clothing, and allowing adequate time for proper digestion by not lying down for about three hours after eating.

Home remedies abound and include eating an apple or part of one, drinking diluted apple-cider vinegar, eating lemons or almonds, or sipping small amounts of chilled fat-free milk or water every one to two hours. No one thing works for everyone, but a trial might be appropriate if you are willing to go out on a limb. I’m even told different apples help for different people.

Zegerid is a combination of omeprazole and sodium bicarbonate for your stomach acid. You might consider returning to your physician to request an alternative medication that could provide better results, or request a referral to a gastroenterologist for a second opinion and other possible options.

To provide related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I changed my diet to avoid foods containing high acids, to no avail. I was on a regular regimen of prescription medications that made me unhappy, so I explored another therapy for this ailment. A friend told me about apple cider vinegar, so I tried three tablespoons in a six ounce glass of water three times a day for five days. I dealt with the nasty taste of the vinegar and had some initial heartburn discomfort, but I didn’t take any OTC meds. I’ve been heartburn-free for over a month and have not taken an acid reducer since I began this therapy. The total cost has been about $2 for the vinegar.

Please pass this remedy along to your readers and patients.

DEAR READER:
I just did! Sometimes we find success in the places we least expect to. If you remain symptom free, you just struck gold. Stick with the regimen and thank your friend.

I believe in alternative therapy as a supplement to modern medical treatment, as it may pave the way to healing and wholeness.

DEAR READER:
Physicians are often reluctant to go the alternative therapy route. Foremost, there is no control over herbal remedies. Ingredients can vary from brand to brand. Doctors take more stock in FDA approved prescription medications that have been appropriately tested and found to work.

Having said this, more and more savvy patients have investigated alternative therapies and prefer to have a greater degree of control over their bodies. For this very reason, naturopaths (doctors of natural therapies) have become very popular across the country. While they cannot prescribe medications, they can offer recommendations for natural treatments and some work in conjunction with medical doctors to ensure the well-being of the patient.

If you and your friend improved, I congratulate you. Remember that alternative therapy can work in some but not in all situations. Stay connected with your primary care physician for the times you might need him or her.

To give you related information, I am sending you a copy of my Health Report “Herbs and Healing Fads”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER: To my knowledge, Nexium is a slightly stronger medication than Prevacid. It also does not have a generic form and can be very expensive.

I recommend that you try over-the-counter medications, such as Pepcid or Zantac. If they do not work for you, you may wish to try Prilosec. This medication was once available by prescription only but was found to be relatively free of side effects. It is now available for over-the-counter sale. If you try these unsuccessfully, you may benefit from comparison shopping your area pharmacies as each one can have a different price for your medication.

Another option is Wal-Mart and Target pharmacies that offer $4 prescription programs. Cimetidine (Tagamet), Famotidine (Pepcid) and Ranitidine (Zantac) are all available through the program. Verify that they can offer the medication you need for $4 because some states have laws that require higher pricing while others still do not allow the product to be sold under the program.

These can be purchased over-the-counter, generally in packages of 10 or 12 pills for individuals with infrequent acid reflux. For people who need the medication daily, such as those with gastroesophageal reflux disease, these programs offer substantial savings.

Speak with your physician. He or she will need to give you a prescription for the medication which you then can take to the pharmacy of your choice. You can find more information regarding these programs online at www.walmart.com and www.target.com

To give you related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I have had this problem for many years, even as a teenager, but it has gotten much worse. My tonsils were removed when I was 21.

I went to a throat specialist and was told it was probably caused by acid reflux. I then had a test done on my esophagus that showed some moderate acid reflux despite the fact I never have heartburn. My throat otherwise looked completely normal. I now take Nexium but continue to have the same mucus problem. It is definitely not a habit. It can happen at nearly any time of the day, even when I am not talking. It sometimes will last for several hours.

I think my doctors are on the wrong track. Can you help me?

DEAR READER: Acid reflux can lead to upper respiratory mucus secretion. However, this condition has been present for decades so I would check out the possibility of an inhalational allergy or other sinus condition such as polyps or enlarged adenoids (the filtering mechanism near the sinuses). You should go back to your ear-nose-and-throat specialist and ask about this. She can test you for any sinus abnormalities. Polyps and enlarged adenoids often respond to steroid nasal spray but may require surgical removal. If, however, the tests are negative, she can give her a referral to an allergy specialist. The allergist should test you for various irritants such as dust, dander, pollen and more. If you do indeed have an allergy, a simple medication, such as Zyrtec or Clarinex should solve your problem. However, if no allergy is discovered, I’m afraid you may fall into a category of individuals who have excess mucus for no apparent reason. This often does not have a single successful treatment but your ENT doctor may be able to offer some suggestions. This may include a humidifier, de-humidifier, air filters, over-the-counter decongestants when needed, and more.

To give you an example of this situation, I had a patient with symptoms much like yours. She was a cat lover and had had many cats over the years. She, for no apparent reason, had suddenly become sensitive to cat dander. The solution was easy for me, difficult for her. She had to give her beloved cats away to other loving homes. Her problem was gone soon after the cats were.

Let me know how this situation works out for you.

To give you related information, I am sending you copies of my Health Reports “Allergies” and “Hiatal Hernia, Acid Reflux and Indigestion”. Other readers who would like copies should send a self-addressed 4 ¼” X 9 ½” letter-sized stamped envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).