Bitter mouth

When a person feels bitterness in his mouth, he does not think about the fact that at that moment the taste receptor cells of his tongue, having responded to the irritation, launched sensory transduction - sent a corresponding signal to the taste analyzer.

In the absence of a direct connection with the food in the mouth, an unpleasant acrid taste - bitterness in the mouth - is considered an anomaly, indicating one or another disorder in the digestive system, metabolism or hormone production.

[ 1 ]

Causes of bitterness in the mouth: main diseases, pathologies and conditions

Before finding out why bitterness in the mouth can appear when you have not eaten anything bitter, it is necessary to emphasize that this taste is perceived by at least three dozen TAS2R receptors. Their signal through transmembrane G-proteins reaches the thalamus, and from there - to the sensory center of taste in the cerebral cortex (in the parietal region of the brain). And the symptoms of bitterness in the mouth - the sensation of a bitter taste and a feeling of disgust - have the same mechanism, which cannot be said about the reasons for its launch.

And the reasons for bitterness in the mouth are very different:

• reaction to certain substances, including poisoning from poor-quality food products, insecticides, heavy metal salts;
• diseases of the gastrointestinal tract and biliary system (gastritis, reflux disease, cholelithiasis, cholecystitis, chronic duodenitis, hepatitis, functional dyspepsia, pancreatic cancer, etc.);
• imbalance of intestinal flora;
• helminthiases (giardiasis, opisthorchiasis, etc.);
• endocrine diseases (diabetes, hyperthyroidism, hyperparathyroidism);
• infectious mononucleosis;
• deficiency of folic acid (vitamin B9), pyridoxine (vitamin B6), cyanocobalamin (vitamin B12);
• zinc deficiency in the body;
• stomatitis, oral candidiasis, reaction to dental materials;
• pregnancy and menopause in women;
• negative side effects of medications;
• stress, increased anxiety, depression.

As you can see, in clinical practice, bitterness in the mouth as a symptom of a disease is considered in many diseases and metabolic disorders, as well as in cases of hormonal changes in the body.

[ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Bitterness in the mouth in the morning

Problems that cause complaints like "I wake up with bitterness in my mouth" are most often rooted in hepatobiliary diseases - pathologies of the gallbladder, bile ducts, and liver. The gallbladder, the main reservoir of bile produced by the liver, accumulates bile so that food can be digested in the small intestines. When bile does not get to where it should - the duodenum - through the bile duct, an excess of it is formed.

And this can be due to the formation of stones in the gallbladder or in the bile ducts. The medical diagnosis is known - cholelithiasis. At the same time, bitterness in the mouth with cholecystitis - inflammation of the gallbladder - is also associated with the loss of stones in the gallbladder. And in patients with chronic cholecystitis, bitterness in the mouth and a temperature of 37 ° C can be combined, which is an indicator of a sluggish inflammatory process in the gallbladder.

Among the symptoms of biliary dyskinesia, that is, a functional disorder of their contraction, bitterness in the mouth after sleep is also noted. This symptom is also caused by gastroduodenal reflux, in which bile enters the stomach cavity due to a malfunction of the sphincter between the stomach and the duodenum (the pylorus). In this case, even bitterness in the mouth will be felt at night, when the stomach is in a horizontal position and relaxed. Other symptoms of gastroduodenal reflux: bitterness in the mouth and heartburn, nausea attacks turning into vomiting bile, bitterness in the mouth and belching, as well as pain in the upper abdominal cavity (under the ribs).

Bitterness in the mouth after eating

If the food is too fatty or spicy, if the portion eaten in one sitting is too large, then bitterness in the mouth after eating is a natural physiological result of overloading the stomach, pancreas and the entire digestive system.

A sore stomach and bitterness in the mouth about an hour after eating is a sign that gives reason to suspect irritable stomach syndrome, which develops due to the consumption of food that is difficult to digest (the same fatty and spicy) or functional dyspepsia. Belching after eating is accompanied by bitterness in the mouth and a sore liver - a consequence of the increased work of this organ, synthesizing bile acids necessary for digesting fatty foods (as well as detoxifying alcohol).

If you, without abusing unhealthy food, feel bitterness in your mouth after eating, then any gastroenterologist, whom you should definitely contact with this problem, will first of all assume that you have either gastritis, or biliary dyskinesia, or gastroesophageal (gastroesophageal) or gastroduodenal reflux.

Bitterness in the mouth with gastritis - an inflammatory lesion of the mucous membranes of the stomach - is combined with such clinical signs as heaviness in the stomach after eating, belching of stomach contents, nausea, heartburn, pain of varying intensity. Patients with gastritis also often experience bitterness in the mouth and a white tongue.

Reflux (reverse movement of the contents of the stomach or duodenum) is characterized by bitterness in the mouth and heartburn - due to bile and, to some extent, pancreatic enzymes entering the esophagus.

With long-term inflammation of the gallbladder - chronic cholecystitis - bitterness in the mouth often appears when eating. This disease also manifests itself with such symptoms as bitterness in the mouth, nausea and weakness, as well as pain in the hypochondrium on the right side.

Systematically occurring belching of air and bitterness in the mouth after eating are caused not only by simple overeating, but may indicate a narrowing of the lumen of the esophagus, a kink in the stomach, as well as a malfunction of the gastroesophageal sphincter (the valve between the esophagus and the stomach).

As medical practice shows, bitterness in the mouth and belching after eating are in many cases the first signals of inflammatory processes in the duodenum or pancreas. Thus, bitterness in the mouth with pancreatitis is dryness in the mouth and bitterness, as well as the appearance of a yellow coating on the tongue. Gastroenterologists advise to keep in mind that the initial stage of pancreatic adenocarcinoma has very similar symptoms.

[ 7 ], [ 8 ]

Nausea and bitterness in the mouth

Therapists, gastroenterologists, and endocrinologists encounter complaints of bitterness in the mouth and nausea every day. First of all, bitterness in the mouth and vomiting are included in the symptom complex of almost all diseases of the digestive system listed in the previous sections. And bitterness in the mouth and diarrhea are characteristic of enteritis, chronic colitis, and colitis of infectious etiology.

Infectious disease specialists note that nausea and bitterness in the mouth during hepatitis cannot be attributed to specific symptoms of this disease, however, before the appearance of yellowness of the sclera and skin (during the first week from the moment of infection), patients experience bitterness in the mouth and a temperature of up to +39°C, chills, nausea, vomiting, muscle pain and pain on the right side under the ribs, loss of appetite and sleep disturbances. In addition, almost everyone with hepatitis (as well as with inflammation of the gallbladder or duodenum) experiences bitterness in the mouth and a tongue coated with a yellow or yellow-brown coating. And with any form of hepatitis, the symptoms include bitterness in the mouth, nausea and weakness.

Frequent attacks of nausea, dryness and bitterness in the mouth (that is, almost the full picture of chronic cholecystitis) appear when the bile ducts of the liver are affected by such a type of helminths as flukes, which can be caught by eating dried river fish infected with parasite eggs. This parasitic disease is called opisthorchiasis, and with it a person has bitterness in the mouth and liver pain.

And with infectious mononucleosis (caused by the Herpes virus type IV), a person's asymptomatic malaise after a few days turns into an obvious illness, in which the temperature rises, the lymph nodes in the neck increase several times, the throat hurts a lot and the bitterness in the mouth is unbearable.

Constant bitterness in the mouth

Constant bitterness in the mouth can be felt for a number of reasons. For example, with cholecystitis, a kink in the gallbladder, liver failure. With a chronic deficiency of folic acid (which is needed to regulate the level of hydrochloric acid in the gastric juice) and vitamin B12 (which helps digest protein foods), digestive problems may appear, in particular, bitterness in the mouth and constipation.

As biochemical studies show, a long-lasting bitter taste can be caused by a disturbance in the sensitivity of the taste buds of the tongue due to a deficiency or excess of zinc in the body. In the first case, taste sensitivity decreases and is defined as hypogeusia, in the second case, it increases (hypergeusia). And it's all about zinc, which interacts with the enzyme carbonic anhydrase IV and regulates the formation of saliva, and also ensures the synthesis of alkaline phosphatase, an enzyme in the cell membranes of taste buds.

Some experts explain bitterness in the mouth in diabetes by the exacerbation of taste buds due to distal sensorimotor polyneuropathy (which can also affect nerve fibers that transmit taste signals); others believe that the cause is an imbalance of electrolytes potassium and sodium - due to a decrease in the functional capacity of the adrenal cortex.

Speaking of neuropathy. In some cases, constant bitterness in the mouth is not related to digestion, but to neurosomatic pathologies, when the afferent fibers of the glossopharyngeal or vagus nerves that transmit taste signals are damaged. The vagus nerve can be damaged when it is affected by herpes viruses, shingles, or tumors of the medulla oblongata. And the glossopharyngeal nerve can be compressed by a tumor of the corresponding localization, for example, in the pharynx, retropharyngeal space, or at the base of the skull.

It should be noted that bitterness in the mouth and headache, as well as bitterness in the mouth and dizziness can be companions of arterial hypotension (low blood pressure). But not primary - idiopathic, but secondary, which occurs with such pathologies as gastric ulcer, hepatitis, pancreatitis, diabetes mellitus, tuberculosis, alcoholism.

Heavy smokers often ask themselves: why, as soon as they quit smoking, did they feel bitterness in their mouth? If there are no other symptoms - heartburn, nausea, vomiting - then the disease has nothing to do with it. And the answer is that among several thousand harmful and simply poisonous substances formed during the pyrolysis of tobacco, there is 3-pyridinecarboxylic acid in cigarette smoke, also known as nicotinic acid, also known as niacinamide, also known as vitamin PP or B3. When the body lacks this vitamin, a person feels a burning sensation in the tongue and bitterness in the mouth. Therefore, having made the right decision to quit smoking, you should replenish your body with vitamin PP by eating rye bread, beef liver, turkey meat, sea fish, buckwheat, beans, mushrooms, beets, peanuts.

But a temporary filling and bitterness in the mouth indicate that the body negatively perceives the filling material that dentists use in multi-stage caries treatment. All these materials - artificial dentin, polycarboxylate cement, vinoxol - contain zinc oxide or sulfate, and how this chemical element affects taste buds has already been discussed above.

Additionally, bitterness and burning in the mouth are reported by almost 40% of postmenopausal women, and researchers believe this is due to decreased estrogen levels.

[ 9 ], [ 10 ]

Bitterness in the mouth in pregnant women

During pregnancy, bitterness in the mouth has at least two causes. The first is hormonal: estrogens and progesterone, the production of which increases significantly, contribute to a decrease in the motility of the gastrointestinal tract and a slowdown in the digestion process. In addition, already a week after fertilization of the egg, it begins to produce human chorionic gonadotropin (hCG). All these hormones block the contractile activity of the muscle tissue of the uterus, but their "blockade" extends to all the muscles of the visceral organs, which leads to temporary dyskinesia of the biliary tract, atony of the gallbladder and intestines.

That is why some women think that bitterness in the mouth is a sign of pregnancy. Of course, this is a wrong point of view, it is just that pregnant women in the early stages have such severe toxicosis and bitterness in the mouth that they console themselves with the inevitability of these unpleasant manifestations when carrying a child. Although during pregnancy, bitterness in the mouth is indeed one of the signs of toxicosis, which is expressed in the specific interaction of acids that are part of the bile.

In addition, the pancreas of pregnant women produces more glucagon. This polypeptide hormone, on the one hand, acts as an intestinal relaxant, and on the other, activates the synthesis of ketone bodies in the liver. This also causes bitterness in the mouth during pregnancy.

The second reason is anatomical: the enlargement of the uterus leads to the displacement of the digestive organs and the entire gastrointestinal tract from their usual physiological positions, which can provoke bitterness in the mouth of pregnant women.

And among the most likely reasons why bitterness in the mouth appears after childbirth, doctors name a decrease in estrogen levels, as well as dysfunction of the adrenal cortex and increased production of cortisol - in response to postpartum stress.

[ 11 ]

Bitterness in the mouth of a child

In principle, bitterness in the mouth of a child occurs for the same reasons as in adults, although, as pediatricians claim, inflammatory hepatobiliary diseases (cholecystitis, etc.) are diagnosed much less frequently in children. But disorders of the bile ducts in the liver, problems with the gallbladder, in which the child suffers from bitterness in the mouth, nausea and weakness, are detected quite often.

Bitterness in the mouth of small children may appear due to food poisoning or the ingestion of lead-containing dyes (used in the manufacture of low-quality toys). Parents should keep in mind that in children aged 6-12, a bitter taste in the mouth may be associated with parasitic diseases: echinococcosis, ascariasis, opisthorchiasis, giardiasis, toxocorosis.

So, bitterness in the mouth with a cough that is very similar to bronchitis, or bitterness in the mouth after coughing is a consequence of giardiasis or toxocorosis, that is, the presence in the body of intestinal lamblia, which can affect the liver, or toxocara, which gets into various tissues and organs. So watch whether the child's stomach hurts after fatty foods, whether he has chills and increased sweating not associated with a cold, whether there is constipation or diarrhea, and whether your child is losing weight due to a decrease in appetite.

[ 12 ]

Bitterness in the mouth after antibiotics

Bitterness in the mouth after antibiotics is a side effect of drugs of this pharmacological group and is caused by several factors. Firstly, the active substances of many antibiotics are metabolized and excreted from the body by the liver and act on it as toxins. And while the liver is cleansed of them, complaints about bitterness in the mouth and liver pain are inevitable.

Secondly, there is a bitter taste in the mouth after antibiotics due to the disruption of the digestive process due to dysbacteriosis. By destroying pathogenic microorganisms, antibiotics simultaneously deal with beneficial ones - bifido- and lactobacteria, bacteroids, clostridia, tooth bacteria, Escherichia coli, which make up the obligate microflora of the intestine. All these microorganisms, helping the liver and intestines, break down and remove metabolites; produce many vitamins and enzymes; participate in metabolism. In general, after antibiotics that destroy this microbiocenosis, the body has to “bring itself back to normal” for a long time.

For example, the antimicrobial and antiparasitic agent Metronidazole and bitterness in the mouth, as well as its synonym Trichopolum and bitterness in the mouth are related to the fact that the use of these drugs causes the cessation of DNA synthesis by cells of not only pathogenic anaerobic microorganisms - Trichomonas, Gardnerella, Balantidia, Giardia, Entamoeba, but also in the same way leads to the end of the existence of obligate microorganisms.

Fromilid and bitterness in the mouth: an antibiotic of the macrolide group, Fromilid (Clarithromycin) is effective in the defeat of the respiratory tract, soft tissues and skin by gram-positive and gram-negative bacteria of the genus Legionella, Mycoplasma, Chlamydia, Ureaplasma, Listeria, etc. The principle of its action is bacteriostatic, that is, the synthesis of proteins in the bacterial cells stops, and they die. Everything else, in accordance with the pharmacodynamics of antibiotics, occurs according to the Metronidazole scheme. And the list of side effects is also practically no different. Taking these drugs causes a strong bitterness in the mouth.

Erespal and bitterness in the mouth: this drug is not an antibiotic; by the mechanism of antiexudative action in bronchial spasm, it belongs to antihistamines. According to reviews of most patients who used Erespal (Fenspiride), prescribed by a doctor for bronchial asthma, the drug causes severe bitterness in the mouth, although this side effect is not indicated in the instructions for the drug.

In addition to antibiotics and antihistamines (antiallergic) drugs, bitterness in the mouth is a side effect of some antifungal and non-steroidal anti-inflammatory drugs, antidepressants, as well as antitumor cytostatics used in chemotherapy of oncological diseases.

[ 13 ]

Diagnosis of bitterness in the mouth

Since bitterness in the mouth is considered a symptom of a disease in many areas of practical medicine, identifying any, including gastroenterological, causes of the appearance of this symptom will require a comprehensive examination.

Diagnosis of bitterness in the mouth in gastroenterology is carried out on the basis of:

• anamnesis, including a list of all pharmacological agents taken by the patient;
• general analysis of blood, urine and feces;
• biochemical blood test (including Helicobacter Pylori and eosinophils);
• blood test for antibodies to hepatitis and herpes virus type IV;
• blood tests for sugar, gastrin, liver phosphases, etc.;
• intragastric pH-metry (determination of the acidity level of gastric juice);
• X-ray examination of the stomach (gastroscopy) and esophagogastroduodenoscopy;
• gastro- or cholescintigraphy;
• ultrasound examination (ultrasound) of visceral organs.

The set of specific diagnostic methods will depend on the specific manifestation of this symptom and is determined by the doctor of the specialization whose competence includes the etiology, that is, the root cause of the occurrence of bitterness in the mouth: gastroenterology, endocrinology, parasitology, gynecology, etc.

[ 14 ], [ 15 ], [ 16 ], [ 17 ]

Treatment of bitterness in the mouth

From a medical point of view, the only correct one in any situation, treatment of bitterness in the mouth can mean symptomatic therapy, since bitterness in the mouth is a sign of one or another pathology. That is, a consequence, not a cause.

That is why, when patients ask what to do if they have bitterness in their mouth, doctors answer: treat the disease that is accompanied by this symptom.

However, the arsenal of symptomatic treatment also includes medications - tablets for bitterness in the mouth.

Thus, Allochol, which stimulates bile synthesis for bitterness in the mouth, is indicated for use in such pathologies as cholecystitis and chronic non-obstructive hepatitis. The recommended dose for adults and children over 7 years of age is two tablets three times a day (after meals); for children under 7 years of age - one tablet.

Choleretic and hepatoprotective agent Hofitol for bitterness in the mouth (other names - Artichol, Holiver, Tsinarix) is prescribed for chronic cholecystitis and hepatitis, liver cirrhosis, decreased contractile function of the bile ducts: 1-2 tablets three times a day (before meals) - adults and children over 12 years old; one tablet three times a day - children 6-12 years old. Side effects include heartburn, nausea, diarrhea, pain in the epigastric region. Hofitol is contraindicated in the presence of stones in the gallbladder and in cases of impaired conductivity of the bile ducts.

With the active ingredient of the plant extract milk thistle, Karsil for bitterness in the mouth (Silibor, Gepabene, Legalon) acts as a hepatoprotector, which ensures the restoration of the structure of damaged liver cells during its chronic inflammation and after hepatitis in adults (three times a day, 1-2 tablets). This medicine is not prescribed to pregnant women or preschool children.

Ursosan and bitterness in the mouth: a drug based on ursodeoxycholic acid (synonyms - Ursohol, Ursolysin, Ursodex) is intended to dissolve cholesterol gallstones in the gallbladder, to treat gastritis with gastroesophageal reflux and primary cirrhosis of the liver. Take one capsule (250 mg) per day, at night. Contraindications of Ursosan: acute inflammation and impaired motility of the gallbladder, calcified stones in the gallbladder, obstruction of the bile ducts, dysfunction of the liver and kidneys, first trimester of pregnancy, children under 6 years of age. Side effects of this drug are expressed in the form of diarrhea, liver pain and urticaria.

Bitterness in the mouth and Odeston: this drug (synonyms - Gimecromon, Izohol, Cholestil, etc.) is a coumarin derivative and is a choleretic, simultaneously relieving spasmodic contractions of the ducts and sphincters of the biliary system. Prescribed 0.2 g (one tablet) three times a day, 30 minutes before meals. Odeston is contraindicated for children under 14, pregnant and lactating women, as well as patients with stomach ulcers, bile duct obstruction and liver inflammation. In many EU countries and the USA, this drug is prohibited.

De-Nol and bitterness in the mouth: the drug De-Nol (Bismuth subcitrate, Bismofalk, Gastro-norm, Bisnol) is prescribed for peptic ulcer disease and irritable bowel syndrome as an antacid that forms a protective mucosal-bicarbonate film on the mucous membranes of the stomach and duodenum. Reduces pepsin activity and the acidity level of gastric juice; immobilizes the Helicobacter pylori bacterium. Recommended dosage: one tablet 3-4 times a day, half an hour before meals. Possible side effects of De-Nol include: nausea, vomiting, diarrhea, constipation, darkening of the mucous membrane of the tongue and feces, itchy skin rashes. De-Nol is contraindicated during pregnancy.

Drug treatment of bitterness in the mouth associated with problems of the digestive system also includes proton pump inhibitors - drugs that suppress the production of gastric juice (with gastroesophageal or gastroduodenal reflux) and prokinetics - drugs to accelerate the movement of food in the stomach (with functional dyspepsia and gastrointestinal dyskinesia).

The first group includes such a remedy for reducing the acidity of gastric juice as Rabimak (Sodium Rabeprazole, Barol, Zulbex, Rabezol, etc.). A tablet of the drug (20 mg) is taken once a day (in the morning). Contraindications to the use of Rabimak include pregnancy, childhood and the presence of malignant tumors of the gastrointestinal tract, and side effects include headache, nausea, diarrhea and dry mouth.

To activate gastrointestinal motility, gastroenterologists prescribe prokinetic drugs. For example, the drug Domperidone (Damelium, Peridon, Motilium, Motilak, Nauzelin, etc.) helps with such dyspeptic symptoms as nausea, vomiting, pain and bloating in the abdomen. Adults are recommended to take one tablet (0.01 g) three times a day (before meals); children weighing 20-30 kg - half a tablet twice a day, over 30 kg - a whole tablet. This drug is contraindicated for pregnant women and children weighing less than 20 kg.

Folk remedies for bitterness in the mouth

Almost all folk remedies for bitterness in the mouth involve the use of medicinal plants for gallbladder pathologies. And of the "distracting" home remedies for combating this symptom, two are considered effective: 1) drink a glass of plain water every day 20-30 minutes before breakfast; 2) chew cloves a couple of times a day - one dry clove bud (we usually put them in marinades).

Everyone knows about the benefits of drinking water on an empty stomach, and it is simply impossible to balance the acid-base composition of the liquid environment in the body without H2O. In addition, we probably forgot that water is one of the main elements of a healthy human diet...

But cloves contain aromatic essential oil consisting of eugenol, humulene and caryophyllene. Eugenol is a phenolic compound and is therefore a strong antiseptic; humulene and caryophyllene are terpene alkaloids (like most coniferous phytoncides) and exhibit antioxidant properties.

To rinse your mouth, you can make a herbal decoction of chamomile, peppermint, thyme (wild thyme): two tablespoons of dry herbs per glass of boiling water (insist in a closed container until cool). Some people find that rinsing their mouth with simple baking soda helps: a teaspoon per 200 ml of boiled cool water.

But taking folk remedies for bitterness in the mouth internally - various herbal decoctions and infusions - without finding out the real cause of this problem is most likely not worth it.

[ 18 ], [ 19 ], [ 20 ]

Diet for Bitterness in the Mouth

As gastroenterologists advise, the diet for bitterness in the mouth should be correct. For pathologies such as cholecystitis (not in acute form), cholelithiasis, dyskinesia of intrahepatic bile ducts and bile ducts, chronic pancreatitis and hepatitis, the diet for bitterness in the mouth is the classic therapeutic diet No. 5 according to Pevzner.

Its observance is prescribed by a doctor based on the results of examination and determination of an accurate diagnosis.

But in any case, proper nutrition for bitterness in the mouth involves giving up everything fatty and fried, hot seasonings, sauces and spices, any canned food and fast food, carbonated drinks and alcohol. It is better to replace butter with vegetable oil, meat broths in first courses - with vegetable soups with cereals and pasta. Instead of pork, you should eat poultry and rabbit, instead of pickles - fresh vegetables.

It is better to stew, bake or boil meat rather than fry it in a frying pan in a large amount of fat. Fresh white bread and buns are, of course, very tasty, but they are too heavy for the stomach if you are bothered by bitterness in the mouth.

It is more useful to eat not three times a day, but five, but in more modest portions. There should be at least three hours between dinner and sleep, and then the bitterness in the mouth after sleep will bother you much less often.

What to drink if you have bitterness in your mouth? Instead of coffee, it is better to drink tea, and green tea at that; kefir and yogurt should be low-fat – this way they are better and easier for the body to digest. Berry kissels, fruit juices – not sour and not containing preservatives – will also be useful. If the acidity of the gastric juice is normal, you can prepare a rosehip infusion. And do not forget to drink plain water – at least 1-1.5 liters per day.

What is the prevention of bitterness in the mouth? If we adhere to the medical point of view, and it, as has already been said, is the only correct one in any situations related to our health, then we need to treat diseases in a timely manner. In the end, our illnesses are part of our life, and our task is to ensure that they do not spoil this life too much. And the prognosis for bitterness in the mouth will largely depend on this.

We hope that this information will encourage you to take such a symptom as bitterness in the mouth more seriously and, if it occurs, will force you to seek qualified medical help.