Gastric or lung ?

[carolg1]

How can we tell where the mucus is actually from lungs or gastric as I have great problems having a jackhammer esophogus first thing in a morning I’m clearing the gross stuff for tw or three hours ?. Any advice please xx

[gutlesswonder]

Hi carolg1

I have struggled with this for many years (27 years post gastro-oesophagectomy op)

There are three principal sources of mucus in the upper body - (1)the sinuses in the head (2)The lungs (3) the stomach.

Together these areas secrete several litres every 24 hours - most of the time we don't notice this quite considerable flow until something goes wrong.

(1) Sinuses - these may over-produce if they are irritated by LPR [laryngiopharyngeal reflux] during night time. Often referred to as post-nasal drip.Typically the consistency is thick, globby, with a yellow/greenish tinge (probably due to dust/bacteria/viral contamination). Tends to accumulate around the voice box where it induces coughing.

(2) Normal secretions are the means by which the lungs keep themselves clean, cilia (microscopic beating hairs) continually waft a sheet of mucus containing inhaled debris up to the throat where it is swallowed automatically. The rate of secretion may increase and so become noticeable in the event of (again) the presence of LPR inhaled into the lungs during sleep. [Of course as distinct from customary bacterial/viral respiratory infections].

This particular class of mucus may be identified due to it's colour - green from stomach secretion reflux and orange if containing bile from duodenal reflux; or a mixture of the two. It tends to be clearer and runnier than (1) above.

(3) Stomach mucus - this secreted by specialist cells in the wall of the stomach and it's purpose is to line the stomach and mechanically protect it from being digested by the very strong hydrochloric acid (HCl) secreted by other cells in order to digest proteins in food.

Generally it is copious, sparkling clear but contains myriad small and large bubbles which give it a very characteristic appearance and so is readily identifiable. The bubbles are formed of CO2 arising from the protective interaction of contained bicarbonate neutralising HCl - another secondary protective mechanism.

With your oesophageal condition I suspect that it may be difficult to determine which of the above or all three are the culprits.

You could reduce the likelihood of LPR being a factor by raising the head of your bed on blocks 10 inches high (not less!), so preventing reflux from welling up during the night.

Given that these conditions are beyond the remit of the average GP I presume you are receiving specialist care with regular monitoring. Has endoscopy been carried out? Have you been diagnosed with an Hernia and/or a dysfunctional lower oesophageal sphincter ?

[carolg1 in reply to gutlesswonder]

Hi, thanks so much for reply and wow how have you coped 27 years I’ve been at it for four years each year worse than the last I have a mix of things going on emphysema a small amount of bronchiectasis and jackhammer esophogus the mornings are generally the worst and copious amounts of clear sometimes very salty bubbly there is that much I can barely breathe, then after I’ve cleared for an hour it starts coming off what feels like my right lung, I had motility test done and a few years back camera down, I cannot have an op as I am not well enough I am told, I will raise my bed and see if that helps it’s such a terrifying ordeal every morning trying to clear my main airway with all the gloop, the consultant does not offer any further advice than panteprazole and carbocystien to thin the lung mucus, it’s like I’m drowning in the stuff. Any advice is really appreciated I have no quality of life at the minute as it takes so long to clear xx

[carolg1 in reply to gutlesswonder]

Can I ask do you spend a whole day expelling the mucus once you are out of bed .? It’s really scaring me. Hope you don’t mind me asking thanks x

[1394paulg in reply to gutlesswonder]

Hi

I’ve been coughing up green/ yellowy mucus which are generally like small worms or spaghetti. I’ve tried breaking it with my fingers out of curiosity ( I know it sounds disgusting)as to its consistency and it’s very hard to crush and is quite solid. I sleep raised with various pillows and mornings waking are the worst but find I have this through out the day to a lesser degree. It’s affecting my lungs ( waiting to see another gastroenterologist and have lung tests after chasing for months).

I have motility problems with my oesophagus and a hiatus hernia but still no treatment options discussed with me.

This has been going on now for approx 2 years.

On lanzoprazole 30mg once a day

Restricted diet

Raised sleeping position

Basically all the usual stuff

Just wondered if anyone experiencing the same sort of mucus and what joy they have had with the NHS to resolve and any advice welcome.

Thanks

[carolg1 in reply to 1394paulg]

Hi, I just wondered how you are getting on with your mucus issues mine has really spiralled out of control and so painful,leaving almost breathless they just keep nodding their heads when I tell them nature of the beast is a favourite answer ,

[tallbear]

Hello there,

I do agree with the main principals of the other chap advising you, the only thing I would add is I wouldn't prop your bed up as it will put your whole body on an angle and make it more likely that you will slip down in the night.

Just prop up your upper half on the bed by means of wedge pillows or a frame and sleep on your back. This way you are less likely to aspirate.

I would also seek specialist advice as no-one should have that much mucus to cope with, it,s the production of which needs to be properly investigated and controlled.

And good luck with it

Richard

[carolg1 in reply to tallbear]

Thankyou Richard I have done this and they are all perplexed by it , is it from my lungs, is it from my stomach , ??? They seem to be guessing but the longer it’s going on the worse I am getting I saw a consultant on weds he is going to try some meds which dry secretions up I pray they work and don’t add to my terror xx

[tallbear in reply to carolg1]

Crumbs Carol, I really do sympathise and wish you the very best, try your best to keep your chin up I know it's difficult with such an extreme problem, let me know how you get on, Thinking of you

Richard

[carolg1 in reply to tallbear]

Thank you Richard x