What is water brash?

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 oesophagus (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 (GORD).

GORD is a common condition of the digestive system. According to experts, the prevalence of GORD is increasing in many developing countries.

GORD symptoms, including water brash, may have a significant effect on work productivity and many other aspects of day-to-day life.

Symptoms

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 GORD than water brash.

Causes

GORD symptoms occur because the normal mechanisms that prevent stomach acid from rising into the oesophagus 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 oesophagus to the diaphragm, affects the movements of these structures during swallowing. If the ligament weakens, people can experience symptoms of GORD, including water brash.

Research suggests that people with GORD may produce excess saliva due to the presence of acid in the oesophagus, which activates the oesophagosalivary reflex.

To test this theory, researchers administered either saline solution or an acid solution into the oesophagus 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.

Treatment

People can try to manage their GORD 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 GORD will often help provide relief from water brash. The goals when treating GORD include:

  • relieving and preventing symptoms
  • improving quality of life
  • decreasing oesophagitis, which is the inflammation of the oesophagus
  • preventing or treating any complications of GORD

Depending on the frequency and severity of a person's symptoms, doctors may recommend one or a combination of the following medications:

  • antacids
  • proton pump inhibitors
  • histamine-2 receptor antagonists

Making lifestyle changes can often help relieve symptoms of GORD. 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

Learn more about what to eat to prevent symptoms of GORD.

Several other home remedies can help alleviate symptoms of GORD. Read about them here.

Other symptoms of GORD

The most common symptoms of GORD are heartburn and stomach acids coming up into the oesophagus. People sometimes describe heartburn as chest pain or burning under the breastbone.

Regurgitation is another common symptom. It occurs in 80% of people with GORD, 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 GORD is difficulty swallowing. About 50% of people with GORD report experiencing food sticking in the chest or not going down the oesophagus properly.

Other, less frequent symptoms of GORD include:

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 GORD 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 GORD may seem almost identical to the symptoms of a heart condition. Anyone with suspected GORD 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.

Summary

Water brash is a symptom of GORD. 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 oesophagus and the salivary glands.

Treating GORD 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.

Email Newsletter

Sign up to the OPA e-newsletter for the latest news updates via email.

Subscribe To Oesophageal Patients Association