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Suggest ways to rule out esophagitis and gastritis

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Posted on Tue, 27 Jun 2017
Question: Im a 72 yo fem. w hx of 4 PE's,have a IVC filter,on Coumadin 3 mg.p.o. Recent PT/INR within my range. We are in motorcoach in remote area of NC. This a.m. coughed up old blood and sev sm. clots ( approx. 2tbl. spoon fulls) I have no chest pain,fever,etc. I had colectomy on 9/16, have lg. hernia which drs. are watching. AlIso hx of sev. gastroparesis and GERD. On meds,and botox 3/15. Was told I had esophagitis and gastritis. I am not sure if episode is result of g.i. bleed,or lung. Hesitant to take my Coumadin tonite. Husband did not take me to local hospital,as i signed myself out in 2014. Afraid to call my dr. in Fla. because hed say go to ER. Any suggestions? Im an RN. I havent had any other episodes today. Thankyou.
doctor
Answered by Dr. Ramesh Kumar (4 hours later)
Brief Answer:
Mild hemoptysis.

Detailed Answer:
Hi,
Thanks for choosing HealthcareMagic for your query.
I am a Gastroenterologist and would be answering your query.

Bloody in sputum is also referred to as hemoptysis in medical terms.Most common Causes of bloody sputum include lung infection with pneumonia, bronchitis, tuberculosis, chest trauma etc but as in your case there are two likely possibilities.
1) Get a PT/INR done again Asap.Coumadin is a abticoagulant and strict PT/INR monitoring is to be done to avoid bleeding which is the most common side effect of this therapy.
Even slight change is doses can increase INR by many times.
2) As you have history of GERD and esophagitis.Most likely cause of bleed in your case is reflux disorder only.See when acid refluxes back into your esophagus it erodes the layer covering esophagus termed medically as mucosa layer.
This erosion leads to inflammation and mild bleeding from site of mucosa erosion.
Initially i would suggest you to go for an endoscopy to rule out site of bleeding.

However just 2 tsf of blood with sputum is not suggestive of any major problem but as you are on a anticoagulant PT/INR should be checked asap.
If reaching hospital is a problem rigt now then you can just wait and watch in case episode repeats itself go for PT/INR asap.
Hope i was helpful.

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (13 hours later)
thankyou. I was assuming it is from stomach or esophagus,as I have multiple episodes of g.i.bleed,and when i had my botox in March I was told then I had erosive esophagitis,and erosive gastritis.A week ago my PT/ INR was within my hnormal range.(2.5-3.0)I did cough up old brown blood ( 2tbl) w several small clots. My concern was..is it my chest or possibly stomach. No hemoptysis today!! My dr. does not have me scheduled for another PT/INR until 6/22. This trip I had two STAT draws in XXXXXXX NC,and my dr. never got results. I then was redrawn in Rutherford NC on 5/30. I have been hesitant to call my doctor as I know his response would be to go to ER. I did state earlier that Im an RN and was admitted to the local hospital here in 2014 w acute diverticulits and due to,poor care i signed myself out,and returned to Fla. and was hospitalized. Thus,my hesitancy to call my physician. Would you suggest NOW a call to him ,advising of my episode,and see what his concerns or recommendations might be?? Thanking you...please see above..I typed in wrong box. thankyou..and yes,I was satisfied w the doctors response.
doctor
Answered by Dr. Ramesh Kumar (14 hours later)
Brief Answer:
Follow up suggestions.

Detailed Answer:
Hi again Dear,
Have gone through your details.
See just on the basis of history its very difficult to say whether its gastric or from lungs.However as you are a diagnosed case of erosive gastritis most likely possible source of bleed is either your esophagus or stomach(can be ulcers also).Bleeding is difficult to quantify clinically. Its very difficult to distinguish whether you are throwing up, coughing, or spitting out bloody material.
However to rule out lung at least X-ray of chest should be done initially along with auscultation of chest(examining by stethoscope).Historic clues are however suggestive of gut as primary source of disease.
PT/INR ideally should be around 1-2.So i would consider 2.5-3(to be on higher side).

See if the episodes repeat itself and bleed volume is more then 15-20 ml then go to emergency room other wise my initially suggestion is take Antacids along with proton pump inhibitors for few days. If blood stops this means that it was due to erosion of esophagus.

Please mention is there any history of recent respiratory tract infection or cough cold coryza etc?

"please see above..I typed in wrong box. thankyou..and yes,I was satisfied w the doctors response".-Can't get what you mean to say dear.

Waiting.
Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar (34 hours later)
Dr. XXXXXXX Wed. 6/7 I responded to your answer,and did have a question on your thoughts about a gastric pacemaker which my Gastroenterologist has been considering. I submitted the question..and also a lengthy "chat". I sent approx .2:00 p.m. ET.6/7.As of today I havent heard. I understand you must be extremely busy,and before my time runs out,I was hoping to hear your thoughts before I sign out and give you an excellent rating! Thanking you for your twp prior thorough replis. Have a wonderful day!
doctor
Answered by Dr. Ramesh Kumar (4 hours later)
Brief Answer:
Please resubmit query regarding gastric pacemaker and chat.

Detailed Answer:
Dear xanax,
I have not received any question regarding gastric pacemaker. Kindly repost the query again or can contact customer care for the same.

Waiting.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar (1 hour later)
Dear Dr. XXXXXXX I cant find my questions and " chat" I wrote to you on Wed. 6/7/17. And i cant find the proper number to use on Customer service. I had just wanted to see what your thoughts are on a gastric pacemaker for gastroparesis. Currently,Weve used Botox q6mos. or sooner,and the pacemaker has been discussed as an option. Its OK..I do appreciate your kind,and thorough responses. Iam going today Friday to recheck my PT/INR. Thankyou for the services you provide. Blessings to you. I will write a good evaluation in the morning. Thankyou,again
doctor
Answered by Dr. Ramesh Kumar (5 hours later)
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Wish you a great luck dear patient.
Its a pleasure to help you.

I wish you all the best.
Follow up with reports.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2500 Questions

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Suggest ways to rule out esophagitis and gastritis

Brief Answer: Mild hemoptysis. Detailed Answer: Hi, Thanks for choosing HealthcareMagic for your query. I am a Gastroenterologist and would be answering your query. Bloody in sputum is also referred to as hemoptysis in medical terms.Most common Causes of bloody sputum include lung infection with pneumonia, bronchitis, tuberculosis, chest trauma etc but as in your case there are two likely possibilities. 1) Get a PT/INR done again Asap.Coumadin is a abticoagulant and strict PT/INR monitoring is to be done to avoid bleeding which is the most common side effect of this therapy. Even slight change is doses can increase INR by many times. 2) As you have history of GERD and esophagitis.Most likely cause of bleed in your case is reflux disorder only.See when acid refluxes back into your esophagus it erodes the layer covering esophagus termed medically as mucosa layer. This erosion leads to inflammation and mild bleeding from site of mucosa erosion. Initially i would suggest you to go for an endoscopy to rule out site of bleeding. However just 2 tsf of blood with sputum is not suggestive of any major problem but as you are on a anticoagulant PT/INR should be checked asap. If reaching hospital is a problem rigt now then you can just wait and watch in case episode repeats itself go for PT/INR asap. Hope i was helpful.