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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes persistent chronic cough post an upper endoscopy?

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2121 Questions

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Posted on Fri, 19 Jan 2018 in Digestion and Bowels
Question: Hi I've been suffering from chronic cough for more than 8 years & lately cough is bloody... I ve had an upper
endoscopy 2 days ago & the report says "reflux esophagitis with 2 short tongues of columnar epithelium found , of which biopsies are taken & send for histopathological diagnosis"
does this mean I have Barrett's esophagus already? what are the biopsies result options?
I am really worried....
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Metaplasia is suggestive of XXXXXXX esophagus.

Detailed Answer:
Hello there,
Thanks for choosing HealthcareMagic for your query .
Have gone through your details and i appreciate your concerns.
As per your query answers are-
The mucosa in esophagus is a stratified squamous epithelium while that in stomach is columnar.Recurrent reflux of acid from stomach to esophagus causes metaplasia(change of one type of cell to other).In your case metaplasia has already occured. Metaplasia increases the risk of future adenocarcinoma by 10%.So yes as there is columnar epithelium in esophagus you are having XXXXXXX esophagus.

Barrett's esophagus has no simple cure, besides surgical removal, which is only performed if the patient has a very high risk of developing esophageal Cancer. Treating the associated acid reflux is important and thats the main stay of treatment in your case.However a final authentic professional advice can be given only after results of biopsy are there.
You would be started on a Proton pump inhibitor which would prevent formation of excessive acid in stomach.
Along with it a motility modulator like domepridon would be given this would slow down the reflux of acid from stomach back into esophagus.Regular monitoring of esophagus through endoscopy would be done initially once a year for few years.

Hope i answered your query well.
Please don't panic too much as XXXXXXX esophagus increases the risk of cancer in only 5-10% .

If you would follow medications properly you could lead a normal life.

Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 22 hours later
thank you so much for your reply.. i just recieved the biopsies report (attached) would you kindly tell me what it means?? I believe it's not XXXXXXX right?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello dear,
I am sorry but esophageal carditis(a very old term now usually not used) means that there is metaplasia i.e squamous epithelium is replaced by columnar cells.However there is no comment on presence of dysplasia or cancerous cells.So its Barrett's esophagus.

Proper management should be done to reduce risk of future carcinoma.

Request your gastroenterologist to start you on PPI-antacids like Rabeprazole with Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back. This should be continued initially for 6 months and thereafter levosulpiride doses would be reduced.
(Mucaine gel ) should be taken 2tsf thrice daily.
Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily should be taken.
please discuss these options with your gastro or treating doctor.

Secondly endoscopy should be done every year to monitor the problem.

Thanks
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
thank u so much for your recommendations. I will sure discuss it with my doctor very soon.

one last question please. I am obese, around 60 kg overweight. Should i consider gastric bypass surgery ? I was told it may resolve the reflux problem

thanks a lot
doctor
Answered by Dr. Ramesh Kumar 22 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello there my dear patient,
Not every patient is a candidate for surgical procedure.

Eligibility criteria's for gastric by pass are-
1)Maximal efforts to lose weight with diet and exercise have been unsuccessful.
2)Body mass index (BMI) is 40 or higher.
3)In case of BMI above 35 you should have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In your case you have gastritis but if symptoms are well controlled by medications then going through gastric bypass is not advisable.Its a complex operation and has many side effects and limitations in long runs.

Over weight is just a factor for GERD and reflux disease like many other factors.I don't think that just by undergoing gastric by pass things could be cured.In fact gastritis is not curable(its well controllable) disease unless caused by H.pylori bacteria.

However final decision depends on your primary gastro.

Start taking Conjugated linoleic acid supplements thrice daily
L carnitine twice daily.
Capsule Black mamba(containing ephedrine) could also help.
They are all supplements and would be available online.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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