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Bad Breath from the Stomach

Bad breath from the stomach is extremely rare. So rare, that of the thousands of people whom I have smelled professionally, I cannot recall even one case in which the stomach appeared to be clearly involved. The esophagus, which connects the stomach with the mouth, is not an open tube, but is closed. Each chunk of food (called a bolus) moves down the esophagus similar to the way that a swallowed frog moves down a snake. Similarly, when one belches, a little bubble of air moves up the esophagus and exits at the mouth. I am not trying to argue that belches don't smell. They can and do. It's just that belching is a once-in-a-while phenomenon. The rest of the time, the esophagus closes off the stomach.

Some people think that the tongue and stomach are connected, perhaps through reflux of liquid. Although I cannot completely rule that possibility out, the smell of tongues has little in common with stomach odors. Furthermore, bad breath can usually be controlled by treatments limited to the mouth itself.

From my experience, when bad breath strikes, the stomach is the last place to look for an answer. In my opinion, a gastroenterologist who performs a gastroscopy (sticking a disgusting tube all the way down into your stomach to see what is going on ) when a patient complains solely of bad breath, instead of first sending the patient to a dentist and otolaryngologist, is not practising good medicine.

The above notwithstanding, both Islamic and Jewish teachings mention the stomach as being involved in bad breath. In the Talmud, it is taught not to indulge in eating raw peas (again, the exact type of pea is unclear). Similarly, Rashi recommended that one walk a little following the meal, in order to prevent bad breath. We cannot rule out the possibility that in ancient times, some foods or habits (perhaps eating in a supine position) were more likely to result in continuous belching).

Perhaps the ancient religious lore is responsible for the common misconception that bad breath is primarily a stomach thing.