Water Brash and Other Pressing GERD Questions, Answered!

by Todd Eisner Patient Expert

Read Dr. Eisner's answers to the latest community questions

What is water brash, what causes it and what treatments are available?

Water brash is a symptom of gastroesophageal reflux disease (GERD) caused essentially by regurgitation of acid from the esophagus. It typically causes a sour taste in the mouth. The treatment of water brash is identical to that of the more classic symptoms of gastroesophageal reflux disease. While at times lifestyle modifications with diet changes, elevating the head of the bed and not eating late at night can resolve symptoms, one frequently needs to take H2 receptor antagonists or proton pump inhibitors to get results.

I recently had my gallbladder removed, but have not felt relief from my symptoms. I am taking reflux medication that is not helping and I'm experiencing weight loss. Is this normal immediately following surgery or could my symptoms be a result of another condition?

Your question is a good one, yet very difficult to answer. There are many possibilities as to why you may be experiencing persistent symptoms, and your doctor will need to come up with a differential diagnosis to rule things out. The only information I have is that you have not felt relief of your symptoms and that you are experiencing weight loss. A lot depends on what your original symptoms were. Assuming that you had classic symptoms of gallbladder disease and an abnormal gallbladder on ultrasound before surgery, and that the gallbladder was inflamed at surgery, it would be possible that symptoms might be normal for someone who just had gallbladder surgery. If your symptoms were atypical, that it is possible that your original symptoms were not related to gallbladder disease. Another possibility is that your current symptoms are related to a complication from the gallbladder surgery.

Starting with the possibility that this wasn't your gallbladder in the first place, diseases that are commonly confused with gallbladder disease are gastritis, peptic ulcer disease, and pancreatitis. Depending on your age, Crohn's disease or irritable bowel syndrome may be in the differential as well. Occasionally, if your pain had radiated to the chest, cardiac and lung disease needs to be considered as well. If you had an open removal of your gallbladder, as opposed to laparoscopic, it can take weeks for the body to return to normal. It would not be unusual to have lingering complaints of abdominal pain, nausea or weight loss. One thing to consider when symptoms persist after surgery, especially when done laparoscopically, is an injury to the bile duct. This typically presents with abdominal pain, fever, weight loss and abnormal findings on imaging studies of the abdomen.

As you can see, the possibilities extend over a wide range. You need to see your doctor and depending on your situation, undergo appropriate testing as indicated.

What options are there fore treating chronic cough caused by GERD that does not respond to medicine?

Cough as an extraintestinal manifestation of gastroesophageal reflux disease is a very difficult thing to diagnosis and treat. First of all, one needs to make the diagnosis. Typically patients have a history of gastroesophageal reflux disease with heartburn that has responded to conventional therapy, but cough persists. Patients will frequently see ear, nose and throat doctors and be treated for sinusitis and post-nasal drip without relief. Pulmonology consultation may lead to treatment for asthma or bronchitis. When nothing else is found, gastroesophageal reflux disease is usually assumed to be the culprit. The best way to diagnose the condition is to do a 24 hour pH study to see if the patient is truly experiencing acid reflux. In this test, a small catheter is inserted through the nose, into the distal esophagus. There is a pH sensing probe at the end of the esophagus, and it is left in for 24 hours. The patient leaves the endoscopy department with the small tip of the catheter exiting the nostril. The probe transmits data to a monitor worn on the waist. The next morning, the patient returns and the monitor is analyzed. If there is no acid present in the esophagus, then the cough is not from acid reflux.

If there is acid present in the esophagus, aggressive treatment should be started. Typically, it is more difficult to treat the extraintestinal manifestations of acid reflux, such as cough, than it is to treat heartburn.

While you should check with your doctor, the use of high-dose proton pump inhibitors (typically Nexium before breakfast and dinner) in combination with an H2 receptor antagonist (typically Pepcid or Zantac at bedtime) for at least two months will usually lead to improvement in cough that is caused by gastroesophageal reflux disease.

Read more about the symtoms of acid reflux mentioned in this post by clicking on this link.

Todd Eisner
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Todd Eisner

Todd wrote for HealthCentral as a patient expert for Digestive Health.