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[DYSPHAGIA] coughing while eating


  • Subject: [DYSPHAGIA] coughing while eating
  • From: eripley@yahoo.com (Irene Campbell-Taylor)
  • Date: Mon, 9 Oct 2000 18:40:48 -0700 (PDT)

I would have her checked for reflux first. It's very
well established that one of the most common causes of
chronic dry cough is reflux. What is not so well
recognized is that the reflux frequently occurs during
swallowing (the LES relaxes every time one swallows)
and that it only has to come up as far as the
receptors at the very lower end of the esophagus that
trigger cough/bronchoconstriction. The following are
only two of the more recent references re this
phenomenon.
.  Madi-Szabo L; Kocsis G . Examination of
gastroesophageal reflux by transabdominal ultrasound:
can a slow, trickling form of  reflux be responsible
for reflux esophagitis?   Can J Gastroenterol 2000
Jul;14(7):588-592
Ultrasound can visualize significant portions of the
upper and lower esophagus; it is without any
instrumental
interference in real conditions and displays events in
motion. PURPOSE: To study the events that occur during
swallowing and
gastroesophageal reflux. Group 1 comprised 25 patients
with retrosternal complaints,
selected for esophageal surface ultrasonography for
endoscopic signs of esophagitis. Group 2 comprised 25
patients who
underwent initial transabdominal ultrasonography. For
3 to 6 h before ultrasonography, nothing was given by
mouth to the 50
patients labelled as having gastroesophageal reflux
disease (GERD). Ultrasonography was then performed for
15 to 20 mins
after drinking one mouthful of water or tea, or
swallowing some saliva to provoke reflux. The events
were recorded on
videotape rolls. Endoscopy was carried out in all 50
cases; in 46 cases (21 and 25 from groups 1 and 2,
respectively), gastric
acidity and bacteriology were subsequently examined
(test meal). Manometry and pH were not measured to
avoid provocation
of reflux by the instruments. Thirty patients without
any esophageal complaints or signs of esophagitis
(though suffering from
gastric and duodenal diseases) were designated as the
control group (group 3). The available results were
compared.
In 32 of 46 patients diagnosed with GERD (69.5% in
groups 1 and 2), a special kind of reflux was observed
by
ultrasonography: a slow, trickling reflux of the
gastric content was seen, mostly after swallowing. A
fast clearance followed four
to six episodes of the trickling reflux, only after an
interval of 0.5 to 2 mins. Only fast refluxes and
immediate clearance were
observed in the control group. The observations above
may indicate a special form of gastroesophageal
reflux, namely, a slow, trickling form of it. It can
be responsible for the development of GERD. Fast
reflux and immediate
clearance are common; however, this special trickling
form was observed only in GERD patients. This may
explain a number of
often contradictory measurements and can make the
effect of cisapride more understandable. A test meal
is always necessary to
distinguish a bilious reflux from an acidic one,
because only the latter may require aggresive
antacidic treatment.

Chronic cough caused by gastroesophageal reflux. 
Nihon Kokyuki Gakkai Zasshi 2000 Jun;38(6):461-465 .
Matsumoto H; Niimi A; Satou S; Kishi K 
The patient was a 29-year-old woman who had suffered
from persistent chronic cough for more than 3 years.
She had been treated with high doses of inhaled
steroids, oral bronchodilators, and oral
corticosteroids on a presumed diagnosis of asthma.
However, her cough was not alleviated by these
treatments, and the patient was referred to our
hospital. She did not exhibit typical GER symptoms
except for belch. Although
esophagoscopy did not disclose reflux esophagitis,
esophageal pH monitoring revealed acid reflux 7 to 8
times higher than the
reference value. The patient was treated with a
proton-pump inhibitor, which markedly alleviated her
cough. Chronic cough due
to GER was diagnosed

--- Ssbmd@aol.com wrote:
> Can you help with ideas?  I did an MBSS today on a
> 50yr old woman with 
> complaint of coughing while eating  every meal for
> the past 6-7 yrs.  She 
> said that she has been to many different MDs
> (referred to me by GI 
> specialist) and nothing has been found.  She stated
> that her mother had the 
> same problem, that it happens with all food and
> liquid, but she "can't even 
> get close to spicy foods" and she is embarassed to
> eat in public.  Medical 
> history is non remarkable.  
> 
> MBSS showed normal swallow.  After about 10 trials,
> she did begin to cough- a 
> small, irritant dry cough, but NO pen/asp.  So, I
> went through the video with 
> her and showed her the normal results.
> 
> I figure that she either has a very hypersensitive
> cough reflex OR this is a 
> learned behavior, and/or hysterical reaction.  
> 
> Question- would it be possible that  EMG biofeedback
> training might help her 
> unlearn this behavior- if that is all it is?  Would
> a referral to a 
> neurologist help rule out a hypersensitive reflex? 
> What about a referral to 
> Dr. Sonies at NIH for evaluation?  (We live
> closeby).
> 
> Thanks- Sharon Kreps
>
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=====
Irene Campbell-Taylor, PhD
Clinical Neuroscientist

If one tells the truth, one is sure, sooner or later, to be found out.
Oscar Wilde.

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