I am a 41-year-old woman. Over the last five years, I have had episodes of GERD, which have been treated with Zantac. In the last two years, I have also had episodes of painful sores on the right side of my tongue. Could this be related to GERD?

W.S.

Gastroesophageal reflux disease (GERD) is a chronic disease caused by reflux of stomach acid into the esophagus as a result of abnormally low pressure in the sphincter that separates these organs. Patients typically complain of heartburn, regurgitation and, occasionally, painful or difficult swallowing. Treatment involves prevention of stomach-acid production with one of many medications available for this purpose. These include ranitidine (Zantac) and omeprazole (Prilosec).

Interestingly, some GERD patients do not experience the typical heartburn symptoms. Instead, they suffer symptoms known as extra-esophageal manifestations, which may include asthma, laryngitis, chronic cough, pneumonia and dental disease. These manifestations typically occur at night when the effect of gravity is less and acid is able to reflux all the way up the esophagus and into the windpipe, larynx or mouth.

To answer your specific question, there have been reports of mouth sores, or oral ulcers, occurring as a result of GERD. The reason is probably acid-induced damage to the lining of the mouth.

Extra-esophageal manifestations are usually more difficult to treat than the usual symptoms of GERD. Thus, your GERD-related heartburn may improve on medication, while your tongue sores may be more resistant. One option is to try a more potent acid suppressive agent such as omeprazole (Prilosec) or lansoprazole (Prevacid).

However, keep in mind that there are other causes of sores in the mouth. These include certain foods (nuts, chocolate, citrus fruits), fever, trauma and certain vitamin deficiencies. In addition, certain inflammatory diseases can affect the mouth, including Crohn's disease and Behcet's disease. Finally, certain infections can cause oral ulcers. The most common are the viral infections responsible for common canker sores. Other infections, such as herpes simplex viruses, can also affect the mouth. It is important to have an evaluation by your doctor for your tongue sores before blaming them on GERD.