Chronic Coughing​

My Girlfriend has suffered from a chronic cough for 15 years. There are many things that trigger it, but the most noticeable are after eating (some foods are worse that others), lying down and temperature changes (going from indoors to outdoors). I estimate she coughs at least once every 30 minutes when awake. Sometimes she will go into a coughing spasm and coughs up a dark yellow fluid. It seems like over the years she has struggled to get a doctor to really take the problem seriously, (she has recently moved to the UK from Iceland) she takes Nexium (a PPI) and has an inhaler, while these may help, the cough persists. She has taken other PPI's as well as Nexium, these not have been any more effective. Her Chest scans are clear. She had an endoscopy last week that shows a sliding Hiatus Hernia and Grade 1 Oesophagitis and Reflux. She does not have typical heartburn symptoms but describes a feeling of sometimes having a carpet behind her sternum. The recommendation is that she continues with the PPI medication but this does not help her cough and we are looking for a way that actually treats this. I believe that she has GERD and that the hernia should be treated and possibly a fundoplication may be needed. We would welcome some advice. Regards

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  • This is unqualified speculation but the cough might be the result of reflux, that might in turn be caused by the hiatus hernia. So if PPI medication does not really help it properly, one option might be the surgical repair of the hiatus hernia. An alternative might be the Linx device, a kind of magnetic bracelet that re-creates the lower oesophageal sphincter valve effect.

    In one sense having a hiatus hernia is something that a lot of people live with and just get on with life, but, on the other hand, prolonged exposure to reflux is not a good thing, and oesophagitis can be an unpleasant condition to have to cope with, especially if it does not improve, and this has to be put on to the scales of decision about possible surgery.

  • Thanks for the info, the Linx device sounds interesting, we will return to the doctor to discuss the results from the endoscopy, the biggest challenge it seems is to get a definitive diagnosis. Once we have this I hope the best way to treat the condition will become clear.

  • Tell her to try chewing gum after eating .

    Also chew gum throughout the day and see if that helps .

  • I chew winterfresh and it helps my coughing fits after eating big time .

  • Thanks

  • Has your girlfriend had any investigation of or treatment for her gallbladder?

  • No, but thanks for the suggestion

  • Reflux is often exacerbated by cholecystectomy since removal of the gallbladder results in a continuous flow of dilute bile.

    Notwithstanding that your girlfriend has not had this surgery I am confident that "coughs up a dark yellow fluid" is indicative of bile reflux which, alarmingly, is being inhaled into the lungs.

    This is extremely dangerous, often resulting in pneumonia which can be fatal.

    The presence of bile in sputum is testable.

    PPIs have no effect on bile.

    Until she is listed for surgery you can effect significant improvement by lifestyle changes in order to mitigate the symptoms and the risk - primarily of diet and sleeping habits.

    The average GP is completely ignorant of this syndrome.

    Act as soon as you can ...... I have been there and only narrowly avoided removal of a lung.

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