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 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 now have a situation with no answer. Salads. I can only eat Boston lettuce without any after effects. The other varieties, particularly Iceberg, cause a high level of indigestion and acid discomfort. I don’t understand why this is.

I have tried over-the-counter remedies but none seem to work well. I have a similar reaction with bananas. Even the smell will upset my stomach.

I am a 91-year-old male, weigh 185 pounds and am in good health (at least for my age!). I don’t have any other digestive problems, my blood pressure is good, etc.

DEAR READER:
For some individuals, lettuce is incompletely digested. This may be your problem. Incomplete digestion can lead to stomach pain, indigestion, gas, bloating and more. To my knowledge, there is no way to avoid this situation other than by not eating lettuce.

My advice is for you to avoid non-Boston lettuce varieties. You may wish to substitute fresh spinach, or better yet baby spinach, for the lettuce. This will allow you to continue eating salads. Spinach is also highly nutritious.