Halitoza sau respiratia urat mirositoare reprezinta o acuza care creeaza adesea disconfort personal si jena sociala. Fiind cauzata cel mai
frecvent de patologii ale cavitatii bucale si nazofaringelui, acesta manifestare poate fi asociata in rare cazuri cu boala de reflux gastroesofagian
(BRGE). Asocierea dintre BRGE si halitoza se propune a fi explicata prin iritarea mucoasei nazofaringelui si limbii posterioare
de catre refluatul acid gastric, cu acumularea de secretii postnazale si saburarea limbii, ce duce la aparitia respiratiei neplacute.
Prezentam cazul clinic a unei paciente de 36 ani care acuza halitoza pronuntata cu puternic discomfort personal si social, la care
multiple examinari au exclus originea stomatologica si rino-laringologica a acesteia. Examenul radiologic baritat si endoscopic au
relevat hernie hiatala axiala cu BRGE si esofagita de reflux gr.II (Savary-Miller). De asemenea, ph-metria diurna a relevat un reflux
gastro-esofagian acid pronuntat, cu un indice DeMeester – 37.5 (N<14.7). Recurenta simptomaticii in pofida tratamentului de durata
cu doza dubla de antisecretorii au servit ca indicatie la interventie anti-reflux. Pacienta a fost supusa interventiei chirurgicale programate
– crurorafie posterioara cu fundoplicatie Nissen-Rossetti laparoscopica. Perioada postoperatorie cu evolutie favorabila, pacienta
externata la a 5-a zi postoperator in stare satisfacatoare. Supravegherea la distanta de 18 luni a relevat disparitia clinicii preexistente cu
normalizarea indicilor ph-metrici, aspectului endoscopic si radiologic, cu amelioararea evidenta a calitatii vietii si confortului social. Deci,
halitoza este o manifestare rara, dar in acelasi timp deranjanta a BRGE, chirurgia laparoscopica anti-reflux fiind capabila sa inlature
mecanismul aparitiei acesteia, cu rezultate favorabile la distanta.

Halitosis, or bad breath, is a complaint that often creates personal discomfort and social embarrassment. Being most commonly
caused by pathologies of the oral cavity and nasopharynx, this manifestation may be associated in rare cases with gastrooesophageal
reflux disease (GERD). The association between GERD and halitosis is proposed to be explained by the irritation of the
nasopharynx and the posterior tongue by gastric acid reflux, with occurrence of post-nasal drip and tongue coating that lead to
malodor breathing. We report a case of a 36-year-old women complaining of pronounced halitosis with strong personal and social
discomfort, where multiple examinations excluded its dental and rhino-laryngeal origin. Barium esophagogram and endoscopic
examination revealed axial hiatal hernia with GERD and reflux-esophagitis grade 2 (Savary-Miller). As well, 24h ph-metry established
a pronounced gastro-esophageal reflux with a DeMeester score of 37.5 (N <14.7). The recurrence of symptoms despite long-term
dual dose anti-secretory therapy served as indication for anti-reflux surgery. The patient underwent elective laparoscopic surgery -
a posterior cruroraphy with Nissen-Rossetti fundoplication. The postoperative period with favorable evolution, the patient was
discharged on the 5th postoperatively day in satisfactory condition. The 18-month follow-up revealed the disappearance of the
pre-existing clinic with the normalization of ph-metric indices, endoscopic and radiological aspect, with obvious improvement in
quality of life and social comfort. Thus, halitosis is a rare, but at the same time disturbing manifestation of GERD, laparoscopic
anti-reflux surgery being able to correct the mechanism of its occurrence, with favorable long-term outcomes.