Case Report: When reflux smells like smoke: a case of phantosmia associated with gastroesophageal reflux

Phantosmia is the perception of an odor without an external stimulus. Gastroesophageal reflux disease (GERD) has been associated with olfactory dysfunction, but phantosmia has rarely been described.

A 40-year-old woman with longstanding GERD developed intermittent perceptions of cigarette smoke during a week of worsening heartburn and bloating. Episodes were accompanied by déjà vu, nausea, and chills. A double-contrast barium esophagram demonstrated a small hiatal hernia and reflux to the thoracic inlet. She reported approximately 80% improvement after starting omeprazole, with brief recurrence during a heartburn flare, and complete resolution at later follow-up. Migraine with aura, allergic rhinitis, focal seizures, and psychiatric causes were considered as alternative explanations.

The close relationship between reflux activity and olfactory symptoms, together with improvement during reflux-directed treatment, supports a plausible association between GERD and phantosmia. This single case does not establish causation, and neurologic and sinonasal etiologies should remain part of the evaluation.