Do I have 'silent' oesophageal reflux?

[exDancer]

I have had a persistant, non productive, irritating cough for 15 years. It keeps me awake at night (my husband now sleeps in another room) and has led to the termination of my teaching career as I cannot control a class with tears streaming down my face. I cannot answer the phone with confidence, attend concerts or church services - even eating out is a nightmare.

I am on omeprazole and ranitidine but they don't seem to be helping. I have gained a lot of weight and suspect the medication may be involved as I really really eat carefully. Is there anyone else in the same situation?

[chris_usa]

There are some medications which can cause a chronic cough, such as certain blood pressure medicines.

Chronic esophageal reflux is one cause, but there are others. I would recommend a complete workup by an internist.

Other factors like diet and exercise may also help.

[exDancer]

Thank you for your answer Chris. Living in the UK I have never heard of an internist, we have to be referred to specialists at the hospital by our GP - so I guess I should ask her. I am on two BP medications Bisoprolol and Lasartan so I wonder if they are causing the reaction. The only exercise I take is swimming as I have arthritis quite severely and am 75 years old.

[gutlesswonder]

In my experience of reflux (different in that I have had an eosophagectomy) the cough is very productive due to acute irritation of the bronchus.Also I have experienced pneumonia due to deeper inhalation.

What is the condition of your teeth ?

One possible test would be to change sleeping position --- those of us who lack an upper and lower oesophageal sphincter often succeed in combating reflux by raising the head legs of the bed by 5 - 7 inches.In terms of the hydraulics this is far more safe and effective than using pillows which can create an host of other problems.

Give it a try ?

[exDancer]

You have much worse problems than me Gutlesswonder. Lifting the head of the bed would cause difficulties as I sleep with my husband (when I sleep) and having once suggested we use different rooms, because my coughing keeps him awake too, was met with a very negative reply I don't see how I can achieve this. I have tried with pillows, but you slide down and this causes backache.

I'm puzzled by the fact that the Omeprazole I have been prescribed for my cough is 'gastro resistant' which means it will not dissolve till it reaches the gut. I understood the acid which is said to be causing my cough is produced in the stomach - so why is the medication not released there? Could this be why its not working?

?

[chrisrob]

Hi BBarb,

I entirely sympathise. The reflux cough was always my worst symptom. And I was a teacher, too! And I would need to sit up for a couple of hours in the middle of the night coughing.

LaryngoPharyngeal Reflux doesn't have to be acidic to cause problems through aspiration.

There is a theory many doctors cling to that stomach acid triggers some kind of reflex via the vagus nerve that triggers the cough. And a study some years ago found that PPIs were effective in reducing cough (as reported by patients) in 20% of cases. Meaning that for at least 80% this wasn't the answer.

Aspiration of refluxate can cause pneumonia or bronchiectasis. It irritates the mucosa of the bronchi producing excess phlegm requiring constant clearing of the throat - and the persistent cough. It can also penetrate the nasal passages resulting in post nasal drip and sinusitis, and even dry eyes and build up of ear wax. It can also harm the teeth (particularly if still acidic) and cause bad breath.

Whilst we have many drugs that are good at reducing acid making reflux less harmful, we don't have an easy way to reduce the reflux itself. The only advice that can be given are lifestyle changes: keeping upright after eating for at least 3 hours, avoiding tight clothing etc and, as GutlessWonder suggests, raising the head of the bed.

In my case, I had to have a fundoplication operation to control the reflux.

(PPIs like omeprazole, need to be absorbed into the bloodstream in the gut rather than dissolve in stomach acid. That explains the enteric coating. They are not a reactive instant antacid but a proactive acid suppressant.)

All the best

Chris

[Hidden]

I think 15 years is far too long to suffer this without having a definitive diagnosis.

As well as the physical issues there are probably some nervous tension issues involved in that you now probably expect to have a problem when the phone rings, and this might make things worse?

I think that in your position I would try and draw up a timeline of everything that has happened, and what has made a difference; and what has not. Then go and see your GP and ask for a review, and a referral to a specialist (perhaps ear, nose and throat / or chest?). They will probably want to give you an X-ray of your lungs if that has not been done for a while.

Does your mouth and throat keep healthily moist of its own accord? I suspect that you have already tried the usual over-the-counter remedies many years ago.

We tend to assume that reflux is acid, but sometimes it is bile / alkali and would not respond to acid-related medication. I think I might experiment by trying gaviscon at night. You can get this over the counter and it works differently by creating a barrier against reflux for a few hours, and the fact of whether this makes a difference or not might be a helpful clue. There are, as Chris has said, many other reasons for a cough than reflux.

It may be that changing medication might make an improvement. Sometimes the pharmacist can help in establishing whether any of the medication you are on can cause this coughing.

A cough is something that GPs deal with very frequently, but if the normal things do not resolve it, it needs a better examination and investigation to try and establish the underlying cause. It is extremely long overdue in your case!

[joghealth]

Have you seen a gastro consultant ? I have the same thing for years , couldn't work , people thought I had the flu ! and going out was a nightmare , I would cough all the time , no kidding . And at night almost for 1 maybe 2 hrs , and as soon as I woke . Am now taking Domperidone , yes it gives me some kind of normal life .