Heartburn and coughing

Hi has anyone got any ideas on how I can deal with heartburn and coughing? I cough when I have acid and when eating, I stopped eating as it was hurting my throat with constant coughing but I also get heartburn/acid if I don't eat so the coughing continues :( I'm taking Lanzaprozol twice a day with Ranitidine and Advanced Gaviscon

I stay clear of acidic foods like fruits etc

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  • Hi Margie,

    Firstly the acidity of food actually makes no difference since it is negligible compared to the reservoir of concentrated hydrochloric acid found in the stomach. (It's like pouring a kettle of water into the sea to warm it up.)

    PPIs (lansoprazole), H2RAs (ranitidine), alginates (Gaviscon) reduce acid but not reflux. It's the reflux (which may be non-erosive, known as NER) breaching the cricopharyngeus (upper oesophageal sphincter), called extra-oesophageal reflux (or commonly LPR) that is causing the cough.

    Management of reflux may be helped by following these lifestyle rules: lose weight if necessary, avoid tight clothing, eat little and often so as not to overfill the stomach, avoid bending or exercise after food that will compress the stomach (though brisk walking to aid peristalsis is good), leave at least 3 hours between your last meal and going to bed, raise the head of your bed by 6 to 8 inches on blocks, lie on your left side.

    I don't know whether you still have an intact oesophagus. If so, if the lifestyle changes do not help, you may wish to discuss the possibility of anti-reflux surgery.

    This NICE options grid is useful for comparing the benefits of medication vs surgery: goo.gl/K6tuNz

  • Margie,

    Since you're taking lansoprazole twice daily, there shouldn't be a lot of acid in the stomach to cause damage. Symptoms could either be due to bile and enzyme damage, which aren't improved by PPIs, or fermentation of retained food. A few thoughts below:

    1. Are you taking PPI as recommended (ie on empty stomach about 30 min before a meal)? If not, this could improve effectiveness. If post-esophagectomy, consider asking for chewable tablets to improve absorption.

    2. Fatty foods increase bile release, and bile can flow back into the stomach easily after esophagectomy due to the surgical takedown of the pyloric sphincter. Maybe assess diet and position during and after meals (upright position). This can help food drain out of the stomach so that is not retained. Have to balance this against minimizing dumping syndrome.

    3. If surgery was for cancer, make sure and tell your surgeon about your current symptoms. I hate to even talk about it, but heartburn and coughing can possibly be signs of something more sinister.

    Take care and good luck. \wc

  • Thanks Chris my surgery was for cancer

  • I think I would make contact with your specialist nurse again to see if they can do something to alleviate the problem. It would be worth checking to see whether you might be having an element of bile reflux, which a PPI would not touch. They can test for this. Reflux itself can cause a cough.

    It might also feasibly be connected with where any surgical joint is. The higher up it is, the greater the risk of lungs being affected when you eat.

    I think you need to have someone look at you and help you understand whether this problem might be improved.

  • Thank you Alan

    No one seems to take me serious when I mention this my surgeon just said "I will have to learn to live with it" so that's what I have been trying to don

    Can acid reflux / heartburn occur if the stomach is empty?

  • Good question about reflux / heartburn on an empty stomach!

    Reflux can be acid or bile and can come up regardless of food intake especially as your sphincter valve has been removed during surgery. Your throat becomes a lot nearer other bits of your digestive system that are no longer so far down as they were. Hence the possibility of bile increasing.

    The reflux may well be not acid, as the acid production is reduced when the stomach is made into a tube to replace the oesophagus. Heartburn is normally the result of reflux on the lining of the oesophagus, causing pain and irritation as the lining cannot cope with the strong chemical effect in the same way as a stomach lining can.

    Your smaller 'stomach' may be empty a fair amount of the time, but

    with this surgery, motility (ie the muscle-driven process of food being taken through the system) is reduced, with the prospect of food hanging around for longer.

    This lack of motility may, I am told, explain why you have not responded to lansoprazole. A drug which stimulates motility such as mento loperamide can help, with gaviscon, so that may be worth a try.

    I hope this helps.

    Alan

  • Thank you Alan I will speak to my GP ASAP

  • Margie

    My experience of this which may help you.

    I found that if I had any reflux then that would bring on the coughing. Even the tiniest amount would have me coughing which, in turn would lead to more reflux (acid). This could happen in my sleep or if I attempted to tie my shoes.

    I have managed to rid myself of this by changing my diet and the amounts I eat at any given time.

    I have stopped eating chocolate and taking sugar in tea or coffee (using a single sweetner instead). Low fat milk only and zero fried food. Sounds really boring but I have come to like what I eat now and have actually developed a fairly good appetite (which I lost after surgery). This has also controlled the Reactive Hypoglycemia which I also developed after surgery.

    It has been trial and error but removing sugar and in particular chocolate, made an instant positive difference for me.

    My theory was/and still is. That the main cause was reflux during sleep caused by eating "bad things"and too late at night. Once the reflux had started it irritates the throat and then becomes a cyclic condition that is difficult to control.

    So I don't eat after 7:00pm.

    If you can stop it during your sleep time I think you may well stop it during the day.

    Good luck.

    Bruce

  • Thank you Bruce I am going to be more strict with what and how I eat I don't have sugar or chocolate but I do tend to make myself eat more and some days the wrong foods

    Your advice is correct and makes sense :) I needed telling lol

    Thanks again

    Marg

  • Margie

    Go for it. Try to see just one thing at a time and if that one thing makes a difference.

    I found that the things I liked were the things that caused issues. Not so easy to give up. But persevere. I'm no saint or role model. Hopefully you will sort it.

  • Bruce you are a saint to me lol I forgot everything I was supposed to do ... Think because I wanted to get back to " normal" but I needed reminding that I can never be like I was before the cancer ! I have been good with eating all day and not eaten after 7pm I'm pleased to say so far all good no acid reflux etc but I know I have to be strict with myself so hopefully I will sort it

    Thank you again and take care

    Best wishes

    Margi

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