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A case of chronic cough caused by achalasia misconceived as gastroesophageal reflux disease.

Kwon HY, Lim JH, Shin YW, Kim CW - Allergy Asthma Immunol Res (2014)

Bottom Line: Finally, she was diagnosed with achalasia.Achalasia is a rare disease accompanied by dysphagia or regurgitation.If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

ABSTRACT
Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

No MeSH data available.


Related in: MedlinePlus

Esophagography shows the typical beaking appearance of the esophago-gastric junction and dilatation of the proximal esophagus (A). After pneumatic dilatation, the contrast media showed good passage (B).
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Figure 3: Esophagography shows the typical beaking appearance of the esophago-gastric junction and dilatation of the proximal esophagus (A). After pneumatic dilatation, the contrast media showed good passage (B).

Mentions: On second admission, her blood pressure was 139/93 mmHg, heart rate was 93/min, respiration rate was 20/min, and body temperature was 36.9℃. Her peripheral blood WBC count was 15,600/mm3 (neutrophils 71.6%, lymphocytes 23.1%), C-reactive protein was 4.83 mg/dL (normal 0-0.3 mg/dL), and erythrocyte sedimentation rate was 37 mm/h (normal 0-22 mm/h). EGD was performed to reexamine the esophageal ulcers and to evaluate gastroesophageal reflux severity. However, the ulcers were completely healed, and there was no evidence of GERD. Plain chest X-ray showed multiple consolidations on bilateral lung parenchyma, and chest CT exhibited multiple patchy ground glass opacities on both lungs. The dilated esophagus was distended with fluid-filled material, which suggested achalasia with aspiration pneumonia (Fig. 1). Esophagography showed symmetric esophageal narrowing and beaking appearance of the esophago-gastric junction level and mild dilatation of the proximal esophageal portion, which were consistent with characteristic findings of achalasia (Fig. 3A).


A case of chronic cough caused by achalasia misconceived as gastroesophageal reflux disease.

Kwon HY, Lim JH, Shin YW, Kim CW - Allergy Asthma Immunol Res (2014)

Esophagography shows the typical beaking appearance of the esophago-gastric junction and dilatation of the proximal esophagus (A). After pneumatic dilatation, the contrast media showed good passage (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214979&req=5

Figure 3: Esophagography shows the typical beaking appearance of the esophago-gastric junction and dilatation of the proximal esophagus (A). After pneumatic dilatation, the contrast media showed good passage (B).
Mentions: On second admission, her blood pressure was 139/93 mmHg, heart rate was 93/min, respiration rate was 20/min, and body temperature was 36.9℃. Her peripheral blood WBC count was 15,600/mm3 (neutrophils 71.6%, lymphocytes 23.1%), C-reactive protein was 4.83 mg/dL (normal 0-0.3 mg/dL), and erythrocyte sedimentation rate was 37 mm/h (normal 0-22 mm/h). EGD was performed to reexamine the esophageal ulcers and to evaluate gastroesophageal reflux severity. However, the ulcers were completely healed, and there was no evidence of GERD. Plain chest X-ray showed multiple consolidations on bilateral lung parenchyma, and chest CT exhibited multiple patchy ground glass opacities on both lungs. The dilated esophagus was distended with fluid-filled material, which suggested achalasia with aspiration pneumonia (Fig. 1). Esophagography showed symmetric esophageal narrowing and beaking appearance of the esophago-gastric junction level and mild dilatation of the proximal esophageal portion, which were consistent with characteristic findings of achalasia (Fig. 3A).

Bottom Line: Finally, she was diagnosed with achalasia.Achalasia is a rare disease accompanied by dysphagia or regurgitation.If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

ABSTRACT
Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.

No MeSH data available.


Related in: MedlinePlus