“Wheezing from the Gut!” GERD: A Forgotten Diagnosis

Abstract

Introduction: A 58-year-old woman with PMH of asthma, COPD, OSA presented with productive cough, wheezing, sore throat, hoarseness and progressively worsening SOB. Patient tried azithromycin and inhalers without improvement. Patient denied any fever, chills, chest pain, nausea, vomiting or abdominal pain. In ED, patient was in mild respiratory distress, given nebulizers and was 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. Patient was treated for COPD/asthma exacerbation with antibiotics, IV steroids, nebulizers and O2 for few days. Since patient’s cough, hoarseness and wheezing did not improve with aggressive therapy, an esophagram done showed significant esophageal dysmotility with marked retention and delayed clearance of barium from the esophagus with component of esophageal reflux and a positive water-siphon test. Patient was started on PPI with rapid improvement of her respiratory status. Patient was discharged with PPI and GI appointment. 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 PPI for 3 months rather than diagnosis testing. If the empiric therapy is unsuccessful, diagnostic tests such as 24-hour esophageal pH test or barium swallow can be performed.Figure 1: Esophagram.Figure 2: Water siphon test.