Clinic Blog 1: GERD

Almost 2 years ago, we organized a post-graduate course about Respiratory Diseases. It was well attended, and a successful one following its predecessor course which was an utmost or near failure. The last topic of the said conference was about Chronic Cough. What set it apart from the other topics that day was that it was the only interactive session and we asked help from UMED. The take home message was simply for cases of chronic cough, think of three differentials - pulmonary (PTB), allergy, or gastrointestinal (GERD). Thankfully, everyone enjoyed the fruitful and productive discussions.

Yesterday, I was able to apply what I've learned from that session. I had a female patient, with 3 months history of dry cough. She already took different classes of cough medications (mucolytics, cough suppressants, etc.) in the past, but nothing seemed to work. She also underwent chest x-ray with normal result, and sputum AFB for 3 days which all yielded negative results. Last week, she sought consult and was also prescribed with a broad-spectrum antibiotic (claimed to be compliant) because of upper respiratory tract infection. There was slight relief of symptoms but the cough was still there.

I extracted that when she was still working with her previous employer, she had several episodes of skipping meals and/or not eating on-time; she drinks coffee (1 cup a day), softdrinks, and loves spicy foods. She also experiences burning abdominal pain at the epigastric area radiating to substernal chest, bloatedness, and early satiety. She doesn't smoke, doesn't drink alcohol, and doesn't take any NSAIDs. There were no BM changes, dysuria, nausea/vomiting, weight changes. I was zero-ing on GERD. My physical examination further proved my point - (+) epigastric tenderness, tympanitic abdomen.  I explained my clinical impression to the patient (& her companion). I prescribed her medications now targetting against the acid reflux which could be the source of her cough & explained my management approach (lifestyle, eating habits, etc.).

All now I could do is hope and pray for her.