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Suggest Treatment For Persistent Chronic Cough And Clear Chest X-ray Result
Question: Hi. Spoke to a Dr on here last week. I've been suffering from a chronic cough for months. Chest X Ray clear, blood tests are fine apart from slightly elevated liver function. General health fine. My GO advised he thinks it's GERD though I get no heartburn only a dry cough and a feeling that something is caught in my throat or congestion at the back of my throat. I was given lansoprazole 30mg twice per day. They eliminated my cough to an extent but my digestive system has now been playing up quite badly and upset stomach, strange pattern of bowel movements, uncomfortable feeling. I have now been put on Ranitidine 300mg 1 per day at bedtime instead for 30 days. Is this as effective as PPI in clearing a cough. Only taken a few but not noticed any real difference yet and my cough has returned. Should my cough be eliminated after 30 days course? I don't want to be taking tablets forever and for stomach problems to continue. What would be causing this problem as never had it before? I'm just wondering if you would recommend any further tests to establish if GERD is actually what is causing this cough? Can you take Ranitidine with high strength multi vitamins?
Brief Answer:
Further evaluation advised
Detailed Answer:
Hi.
Thanks for posting query at HCM.
I've read your history and understood your concern.
Lansoprazole is a proton pump inhibitor (PPI) that decreases acid production in stomach and is usually advised if a physician suspects OR diagnoses GERD in a patient. It's generally advised to take a PPI for 6 to 8 weeks and if symptoms ( in your case- chronic cough) do not resolve , further evaluation is required.
After using lansoprazole, if you experienced from upset stomach or altered bowel habits, you may have switched to any other other drug of the same class ( like pantoprazole, esomeprazole, omeprazole- which have same therapeutic effects as lansoprazole but may not cause changes in bowel habits).
Tests advised:
1. 24 hr pH monitoring
2. H.pylori Urea breath Test
3. upper GI Endoscopy is recommended in young (age<45) ( usually if symptoms do not subside after taking a PPI for 6 to 8 weeks)
Please discuss about endoscopy with your treating gastroenterologist
Stop Ranitidine and you may switch from lansoprazole to any other PPI, until test results awaited. further advice may be given after test results.
Furthermore,
avoid fat meals at night and use less salt
eat fresh fruits everyday
avoid junk food
eat dinner atleast "3 hours before going to bed"
include plain yogurt in your meal
loose weight if overweight or obese
Hope to answer your concern.
Further questions are most welcome.
Wish you good and sound health.
Regards,
Dr Tayyab Malik
Further evaluation advised
Detailed Answer:
Hi.
Thanks for posting query at HCM.
I've read your history and understood your concern.
Lansoprazole is a proton pump inhibitor (PPI) that decreases acid production in stomach and is usually advised if a physician suspects OR diagnoses GERD in a patient. It's generally advised to take a PPI for 6 to 8 weeks and if symptoms ( in your case- chronic cough) do not resolve , further evaluation is required.
After using lansoprazole, if you experienced from upset stomach or altered bowel habits, you may have switched to any other other drug of the same class ( like pantoprazole, esomeprazole, omeprazole- which have same therapeutic effects as lansoprazole but may not cause changes in bowel habits).
Tests advised:
1. 24 hr pH monitoring
2. H.pylori Urea breath Test
3. upper GI Endoscopy is recommended in young (age<45) ( usually if symptoms do not subside after taking a PPI for 6 to 8 weeks)
Please discuss about endoscopy with your treating gastroenterologist
Stop Ranitidine and you may switch from lansoprazole to any other PPI, until test results awaited. further advice may be given after test results.
Furthermore,
avoid fat meals at night and use less salt
eat fresh fruits everyday
avoid junk food
eat dinner atleast "3 hours before going to bed"
include plain yogurt in your meal
loose weight if overweight or obese
Hope to answer your concern.
Further questions are most welcome.
Wish you good and sound health.
Regards,
Dr Tayyab Malik
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hi Dr XXXXXXX
Thank you for your response. Even though I've had the cough for a number of months I've only recently started to take the lansoprazole abs after 2 weeks of treatment the stomach problems occurred. I did take Omeprazole previously a ge months back but again similar symptoms with stomach problems afterwards.
What is your rationale behind stopping the ranitidine? Presumably it is not as effective as PPI's?
As I have not taken any treatment continuously for 6-8 weeks would you recommend I try a course of something else before having upper Gi endoscopy? Maybe Nexium and what would be your recommended dosage?
I had a H Pylori blood test but that was negative
It still makes me wonder if GERD is the actual cause of the cough or whether it could be something else. Would GERD only normally give symptoms of chronic cough and mucus/lump feel at the back of the throat? There is no heartburn which I thought was the main symptom.
Thank you.
Thank you for your response. Even though I've had the cough for a number of months I've only recently started to take the lansoprazole abs after 2 weeks of treatment the stomach problems occurred. I did take Omeprazole previously a ge months back but again similar symptoms with stomach problems afterwards.
What is your rationale behind stopping the ranitidine? Presumably it is not as effective as PPI's?
As I have not taken any treatment continuously for 6-8 weeks would you recommend I try a course of something else before having upper Gi endoscopy? Maybe Nexium and what would be your recommended dosage?
I had a H Pylori blood test but that was negative
It still makes me wonder if GERD is the actual cause of the cough or whether it could be something else. Would GERD only normally give symptoms of chronic cough and mucus/lump feel at the back of the throat? There is no heartburn which I thought was the main symptom.
Thank you.
Brief Answer:
kindly read detailed answer below
Detailed Answer:
hi.
thanks for getting back to me.
kindly find answers for your queries one by one below.
1. yes, PPI is a better option than ranitidine as PPI "directly" inhibits the acid production while ranitidine "indirectly" inhibits the acid production. PPI is more potent than ranitidine.
2. Nexium is a good option. you may take it atleast for 6 to 8 weeks. i hope , you recover completely but if the symptoms persist , then you may go for the endoscopic examination.
3. its a good sign that your H.pylori negative. You do not need to repeat test.
4. no doubt, heartburn is the most common presentation of GERD in "most of the patients" ( not each and every patient).
You may take a PPI ( nexium) 40mg once daily before breakfast for atleast 6 to 8 weeks alongwith eating habits as mentioned in previous answer. Hope it works. if not, you may undergo endoscopic examination.
Hope to answer your concern.
Wish you good and sound health.
if no further questions, kindly close dialogue box and rate answer.
In future, you may post a direct question to me via HCM portal.
http://doctor.healthcaremagic.com/Funnelpage=askDoctorDirectly&docId=71638
Regards
Dr Tayyab Malik
kindly read detailed answer below
Detailed Answer:
hi.
thanks for getting back to me.
kindly find answers for your queries one by one below.
1. yes, PPI is a better option than ranitidine as PPI "directly" inhibits the acid production while ranitidine "indirectly" inhibits the acid production. PPI is more potent than ranitidine.
2. Nexium is a good option. you may take it atleast for 6 to 8 weeks. i hope , you recover completely but if the symptoms persist , then you may go for the endoscopic examination.
3. its a good sign that your H.pylori negative. You do not need to repeat test.
4. no doubt, heartburn is the most common presentation of GERD in "most of the patients" ( not each and every patient).
You may take a PPI ( nexium) 40mg once daily before breakfast for atleast 6 to 8 weeks alongwith eating habits as mentioned in previous answer. Hope it works. if not, you may undergo endoscopic examination.
Hope to answer your concern.
Wish you good and sound health.
if no further questions, kindly close dialogue box and rate answer.
In future, you may post a direct question to me via HCM portal.
http://doctor.healthcaremagic.com/Funnelpage=askDoctorDirectly&docId=71638
Regards
Dr Tayyab Malik
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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