Persistent cough: A question for the gastroenterologist?

Case

An 80-year-old female retired teacher was admitted under the medical team with right-lower-lobe pneumonia.

The patient, a non-smoker with minimal alcohol intake, had a medical history of non-Hodgkin's lymphoma treated with radiotherapy and splenectomy 30 years before, Barrett's oesophagus (C9M9 Prague Classification) with distal oesophageal ulcer diagnosed 8 months previously, hiatus hernia and dual-chamber pacemaker for sinus-arrest. Medications were omeprazole 80 mg and ranitidine 300 mg daily.

During the preceding two years, the patient had consulted Respiratory and Gastroenterology teams for a persistent cough worsened by eating and drinking and two stone weight loss (admission BMI 16). High-resolution CT demonstrated subsegmental atelectasis and ground glass changes in the lower lobes consistent with chronic aspiration or infection. Her symptoms were attributed to recurrent aspiration due to persistent reflux and poor swallow.

During the medical admission, a follow-up oesophagogastroduodenoscopy (OGD) for Barrett's oesophagus was performed (figure 1) and biopsy samples obtained.

During the OGD, flushing with...

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