Written by Jessica Caporuscio, Pharm.D.
People with gastroesophageal reflux disease may experience a symptom called water brash. Water brash occurs when a person produces an excessive amount of saliva that mixes with stomach acids that have risen to the throat.
A person experiencing water brash can get a bad taste in their mouth and feel heartburn. Doctors sometimes refer to water brash as pyrosis idiopathica, acid brash, or hypersalivation.
Water brash is different than regurgitation — in which a mixture of stomach acids and, sometimes, undigested food comes up into the esophagus (food pipe) — due to the excessive salivation that it involves.
Keep reading to learn more about water brash, including the associated symptoms, possible causes, and treatment options.
What is water brash?
Water brash is a typical symptom of gastroesophageal reflux disease (GERD).
GERD is a common condition of the digestive system. According to experts, the prevalence of GERD is increasing in many developing countries.
GERD symptoms, including water brash, may have a significant effect on work productivity and many other aspects of day-to-day life.
In people with water brash, the salivary glands tend to produce too much saliva. The excess saliva can combine with stomach acids and cause heartburn. People describe heartburn as a burning sensation behind their chest bone. Sometimes, a person may also get a sour taste in their mouth.
Regurgitation is a more common symptom of GERD than water brash.
GERD symptoms occur because the normal mechanisms that prevent stomach acid from rising into the esophagus fail to function correctly. In many cases, this is because the lower esophageal sphincter is not working properly.
Another mechanism that can fail is the function of the phrenico-esophageal ligament. This ligament, which attaches the esophagus to the diaphragm, affects the movements of these structures during swallowing. If the ligament weakens, people can experience symptoms of GERD, including water brash.
Research suggests that people with GERD may produce excess saliva due to the presence of acid in the esophagus, which activates the esophagosalivary reflex.
To test this theory, researchers administered either saline solution or an acid solution into the esophagus of 15 volunteers. They noticed an increase in the production of saliva in response to the acid.
Saliva is less acidic than the contents of the stomach. Therefore, the increased production of saliva that occurs with water brash may help reduce the acidity of the stomach contents.
People can try to manage their GERD symptoms, including water brash, with over-the-counter (OTC) medications. A local pharmacist or another healthcare professional can offer them advice on the best treatment.
If the symptoms are severe or last longer than 2 weeks, a person should consult a doctor. Some people may need a referral to a gastroenterologist.
The treatment for GERD will often help provide relief from water brash. The goals when treating GERD include:
- relieving and preventing symptoms
- improving quality of life
- decreasing esophagitis, which is the inflammation of the esophagus
- preventing or treating any complications of GERD
Depending on the frequency and severity of a person’s symptoms, doctors may recommend one or a combination of the following medications:
- proton pump inhibitors
- histamine-2 receptor antagonists
Making lifestyle changes can often help relieve symptoms of GERD. These may include:
- avoiding large meals close to bedtime
- quitting smoking, if applicable
- achieving and maintaining a moderate body weight
- avoiding foods and drinks that trigger symptoms, such as spicy foods, greasy foods, and alcohol
Several other home remedies can help alleviate symptoms of GERD. Read about them here.
Other symptoms of GERD
The most common symptoms of GERD are heartburn and stomach acids coming up into the esophagus. People sometimes describe heartburn as chest pain or burning under the breastbone.
Regurgitation is another common symptom. It occurs in 80% of people with GERD, with its severity varying among individuals.
People describe regurgitation as a sour taste or the feeling of fluid moving up and down in the chest.
The third most common symptom of GERD is difficulty swallowing. About 50% of people with GERD report experiencing food sticking in the chest or not going down the esophagus properly.
Other, less frequent symptoms of GERD include:
- chest pain
- a cough
- a sore throat
When to see a doctor
When a person experiences heartburn, they may first try managing their symptoms with OTC medications. If these remedies do not provide relief, the person should consult a doctor.
Anyone experiencing severe symptoms that affect their quality of life should seek medical attention.
People should also seek medical attention if GERD symptoms:
- last longer than 3 months with severe or nighttime heartburn
- persist after taking OTC medications, which may include antacids, histamine-2 receptor antagonists, or proton pump inhibitors
- continue when taking prescription-strength histamine-2 receptor antagonists or proton pump inhibitors
It is also advisable for someone to see a doctor if they experience:
- new onset of heartburn or regurgitation between the ages of 45 and 55 years
- blood in the vomit or stool
- anemia (iron deficiency)
- voice hoarseness, wheezing, coughing, or choking
- unexplained weight loss
- continuous nausea, vomiting, or diarrhea
It is important to be aware that the symptoms of GERD may seem almost identical to the symptoms of a heart condition. Anyone with suspected GERD symptoms who also has any of the following symptoms must seek emergency medical attention:
- chest pain radiating to the shoulder, arm, neck, or jaw
- profuse sweating
- shortness of breath
Pregnant and breastfeeding women should also speak with a doctor before taking an OTC heartburn medication.
Children under the age of 12 years should not take OTC antacids or histamine-2 receptors without their parents or caregivers taking them to see a doctor first.
People younger than 18 years should avoid taking OTC proton pump inhibitors without speaking to a doctor.
Water brash is a symptom of GERD. People with water brash produce excessive amounts of saliva. When the saliva combines with stomach acids, a person may experience heartburn and a sour taste in their mouth.
Researchers suggest that the excessive production of saliva is a result of stomach acids stimulating a reflex pathway between the esophagus and the salivary glands.
Treating GERD should resolve water brash, which can affect a person’s quality of life.
Depending on the severity and frequency of a person’s symptoms, doctors may recommend lifestyle changes or a combination of dietary changes and medications.