A 58-year-old woman with PMH significant for asthma, COPD, history of breast cancer s/p mastectomy on Tamoxifen, OSA, RA and a recent admission 3 weeks ago for asthma exacerbation; presented to the Emergency Department(ED) with productive cough, wheezing, sore throat, hoarseness and progressively worsening SOB. The patient tried azithromycin and inhalers at home but without improvement. She denied any fever, chills, chest pain, nausea, vomiting or abdominal pain. In the ED, the patient was in mild respiratory distress, was given nebulizers and admitted to medicine.
Physical exam was remarkable for diffuse wheezing and mild epigastric tenderness. CBC and BMP were unremarkable. CXR was negative for focal consolidation or vascular congestion. Initially, the patient was treated for COPD/asthma exacerbation with Antibiotics, IV steroids, nebulizers and O2 for few days and pulmonary were consulted. Since patient’s cough, hoarseness and wheezing did not improve with aggressive therapy, an esophagram done showed a significant esophageal dysmotility and marked retention and delayed clearance of barium from the esophagus with component of esophageal reflux. Subsequently, she was started on Proton Pump Inhibitors(PPI) for GastroEsophageal Reflux Disease(GERD) with rapid improvement of her respiratory status. The Patient was discharged with PPI and GI appointment as outpatient.
Wheezing is a common manifestation of respiratory illness in adults. While wheezing typically is secondary to airway obstruction due to asthma or COPD, wheezing is also caused by a spectrum of other processes that can be present on their own or coexist with asthma or COPD, contributing to difficult to control symptoms. GERD is known to cause wheezing by bronchoconstriction, increased vagal tone and microaspiration of gastric contents into the upper airway. If GERD is suspected, patient will benefit from a trial of proton pump inhibitors for three months rather than diagnosis testing. If the empiric therapeutic trial is unsuccessful, diagnostic tests such as 24-hour esophageal pH test or barium swallow can be performed.
The most common cause of recurrent wheezing is asthma; but if the symptoms are difficult to control, other diagnosis such as GERD should be taken into consideration because a simple treatment with PPI would be enough to treat the patient.
To cite this abstract:Abed J, Judeh H, Abed E, Gurunathan R, Kotler D. “Wheezing from the Gut! Gerd: A Forgotten Diagnosis”. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 424. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/wheezing-from-the-gut-gerd-a-forgotten-diagnosis/. Accessed April 7, 2020.