DEAR DR. GOTT: In January 2011, your column responded to a 19-year-old who had a chronic cough for 16 months. I, too, had a chronic cough whenever I sat, stood, laughed, was around smoke or after exercising. It lasted more than 15 months. My other symptom was hoarseness with a sensation of something in the back of my throat. I had been put on prescription cough syrups and pills. I had also tried some of the same medicines that were mentioned in your column, including those for asthma, acid reflux and allergies. I was asked about acid reflux but hadn’t had the usual symptoms for it. I saw an allergist and a pulmonologist. I had a chest X-ray, allergy tests, CT scans of my sinuses, breathing tests and a bronchial scope.
While awaiting an appointment with yet another doctor about the cough, I had my yearly pap test, and blood was also found in my stool. I was set up to have a colonoscopy with the new physician. Before the testing, I told him about my other symptoms, and he told me he would do an EGD (esophagogastroduodenoscopy) at the same time.
The results of the EGD showed that I have Barrett’s esophagus, resulting from acid reflux. It was also found that the blood in my stool was coming from my esophagus. I underwent a laparoscopic fundoplication, with a full wrap of the stomach around the lower-esophageal sphincter. My first EGD was done in 2008, the surgery was in 2009; a second EGD was done in 2010, and I now won’t need another one until 2012. I just thought I would send this information so you could possibly pass it on to the person in your column.
DEAR READER: Since that article appeared, I have received several letters regarding readers’ experiences. Yours was not the only to suggest Barrett’s esophagus and acid reflux as a possible cause.
Barrett’s esophagus is a relatively uncommon condition affecting about 1 percent of American adults. It is most commonly diagnosed in those age 50 or older and in those who have acid reflux. Men are twice as likely to develop the condition as are women, with Caucasian men most affected. It causes the lining of the esophagus to change so that it resembles the lining of the intestine. It is most commonly associated with reflux symptoms but by itself does not cause signs. Rarely, sufferers may develop a fatal type of esophageal cancer. Barrett’s may be present for many years before this cancer, known as esophageal adenocarcinoma, develops. Unfortunately, it often isn’t detected until late stages, when treatment is not very effective.
Barrett’s esophagus doesn’t typically require treatment unless severe changes or cancer are detected. Treatment can include photodynamic therapy to destroy precancerous and cancerous cells, endoscopic mucosal resection to removed the affected portions of the esophageal lining, and surgical removal of most of the esophagus.
Other readers also related their experiences. One found it was caused by certain cholesterol medications. Another determined it was caused by ingesting gluten. Someone else discovered that toothpastes containing sodium lauryl sulfate (which I have written about in regards to mouth sores/ulcers) caused hers.
One reader experienced a chronic cough for well over 15 years before it was discovered that she had thyroid nodules that were found to be cancerous. Thyroid enlargement can cause a choking feeling and hoarseness, which may lead to coughing. Treatment depends on the cause. An overactive thyroid may require anti-thyroid medication. An underactive thyroid requires supplemental thyroid hormones. Cancer often requires surgical removal of the thyroid, followed by supplemental hormones to replace those the gland previously made.
Someone else suggested Alpha-1 antitrypsin deficiency. This is a genetic condition that results in emphysema. It is rare, affecting only about 1 percent or 2 percent of all emphysema sufferers. People who have the condition are at high risk of developing emphysema. Smoking increases that risk and often causes emphysema to occur at an early age (30 to 40).
A final suggestion was cardiac abnormalities. Heart-rhythm abnormalities, congestive heart failure and more can all result in coughing. If, after appropriate pulmonary and blood tests fail to identify a cause for chronic cough, cardiac evaluation becomes a logical next step. If there is a strong family history of cardiac problems, this should rise up the list of possible causes.
As you can see, cough is a fairly broad symptom and can be the result of a wide range of health issues.
Readers who are interested in learning more about cardiac and/or pulmonary conditions can order my Health Reports “Coronary Artery Disease” and “Pulmonary Disorders” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order per report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.
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