Association Between Halitosis and Gastrointestinal Disorders: A Review

Abstract

Background The complaint of halitosis among patients with gastrointestinal disorders (GD) is considerable. This review aims to bring a halitosis conceptual and etiological approach to clarify its association with GD.Types of Studies Reviewed A search was conducted in PubMed and Web of Science for papers discussing about any gastrointestinal disorder and its association to halitosis. The original studies regarding this association had its results included in this narrative review and were discussed along the text.Results Halitosis origin is in the oral cavity in about 85% of the cases, while extra-oral halitosis associated with GD corresponds from 0,5% to 1% of cases. Gastroesophageal Reflux Disease (GERD) and the infection by Helicobacter pylori in gastritis cases are the main GD that brings the halitosis symptom along with other manifestations. Inflammatory Bowel Diseases (IBD) are also related to halitosis. In GERD, the esophagus shows pathologic alterations in its functioning that result in the expelling of gastric gases associated to bad breath through the mouth. The presence of Helicobacter pylori is associated with an increase of the volatile sulfur compounds (VSC) due to its capacity of producing such gases in its metabolism. IBD may alter the bowel permeability, allowing VSC to enter in the bloodstream and be exhaled during breathing.Practical Implications The biologic plausibility of the halitosis and GD relation is undeniable and deserves a multidisciplinary approach. Despite the limited number of studies, inflammatory bowel diseases are associated with halitosis in the available evidence.

Keywords

• Halitosis
• gastrointestinal diseases
• gastroesophageal reflux
• Helicobacter pylori
• inflammatory bowel diseases