What Is Water Brash?

Medically Reviewed by Minesh Khatri, MD on September 08, 2023
4 min read

If you suffer from gastroesophageal reflux disease (GERD), you may develop a symptom called water brash. This happens when your body makes too much saliva, causing it to mix with your stomach acid and back up into your throat.

Water brash may also be called pyrosis idiopathica, acid brash, or hypersalivation. It appears to be similar to regurgitation, but it isn’t. Regurgitation is a mixture of stomach acid and undigested food. It's more common with GERD than water brash. ‌

This can be confusing because if undigested food is present when an instance of water brash occurs, it may come up into your esophagus. The main difference is that water brash is accompanied by excessive salivation while regurgitation is not. Water brash causes you to have heartburn and may lead to a bad taste in your mouth.

GERD symptoms develop because your body’s normal functions that keep stomach acid in your stomach stop working properly. Oftentimes, it's the lower esophageal sphincter, a flap that keeps stomach contents down, that stops functioning and causes symptoms. 

You also have a phrenico-esophageal ligament connecting the tissue between your esophagus and your diaphragm. It's designed to manage the movements of swallowing. If this ligament sustains damage, it may lead to symptoms of GERD, like water brash, impacting you.‌

Some medical research shows that excessive saliva production is your body’s response to acid in your esophagus. It activates as a way of addressing the acid but can worsen your condition instead. 

When you eat and swallow, muscles in your esophagus contract to push food down into your stomach. The lower esophageal sphincter opens to allow food into your stomach but usually shuts afterward to prevent contents from going upward.

GERD occurs when your stomach contents flow back up into your esophagus, a path that is usually blocked. It's common for some food to back up temporarily into your esophagus right after eating. But it happens so briefly that you may not even notice it.‌

If food backs up into your esophagus too often, it can damage the tissue, leading to inflammation and worsening symptoms. Long-term damage may also occur if the food that backs up contains too much acid.

Water brash is one of the less common symptoms of GERD. Other more common symptoms include:

  • Heartburn – A sensation behind your chest plate caused by stomach contents irritating your esophageal lining.
  • Chest pain – Your chest may feel tight or have a burning pain that's different than heartburn. The pain may radiate from your back, neck, jaw, and even your arms. Chest pain can be a sign of a heart attack, so always seek immediate medical attention if you experience severe chest pain. 
  • Difficulty swallowing or globus sensation – You may feel like you have a lump stuck in your throat that you cannot get relief from.
  • Pain with swallowing – This is a less common symptom and often indicates an ulcer in your esophagus.
  • Nausea
  • Losing your voice or changes in how you sound when you talk
  • Persistent sore throat
  • Chronic cough without explanation
  • Lung infection
  • Chronic sinusitis
  • Dental disease

You’re at an increased risk for developing GERD if you:

  • Are obese
  • Have a hiatal hernia that causes the top of your stomach to bulge 
  • Are pregnant
  • Have a connective tissue disorder, like scleroderma
  • Suffer from slow digestion

You may also have health conditions affecting your esophagus that lead to GERD and water brash. Esophageal stricture, or the narrowing of your esophagus, is caused by scar tissue that narrows the passageway food uses from your mouth to your stomach.

An open sore called an esophageal ulcer may form and bleed, causing pain and inflammation. Barrett's esophagus is a chronic condition that increases your risk of esophageal cancer because of persistent damage to the area.

There are many over-the-counter (OTC) medications that may help manage your water brash symptoms. Talk to your doctor about your symptoms before starting a new medication. They may have a recommendation for something that can address multiple symptoms if your GERD causes other issues. These may include antacids, proton pump inhibitors, or histamine-2 receptor antagonists.‌

If your symptoms persist for longer than two weeks, your doctor may refer you to a specialist, like a gastroenterologist. Goals of GERD treatment include:

  • Relieving your current symptoms
  • Healing damage to prevent future symptoms
  • Improving your quality of life
  • Decreasing inflammation in your esophagus ‌
  • Addressing any complications caused by your symptoms 

Your doctor may also recommend lifestyle choices that impact water brash symptoms, including: 

  • Eating smaller meals, especially close to bedtime
  • Stopping smoking
  • Losing weight if needed or maintaining your weight within a healthy BMI range‌
  • Avoiding some food and drinks like spicy food, greasy food, and alcohol