Spontaneous gagging can have many causes

Q. Thank you for your balanced, sensible and unbiased information. It is a breath of fresh air.

My husband has a problem with spontaneous gagging. It does not seem to be related to eating, foreign objects or any activity in particular. It has caused him to pull the car over or stop talking with clients.

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.

A. 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.

© 2010, United Feature Syndicate, Inc.