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James asked...

Hello, I have been visiting my GP for the past 14 months, approx 7/8 times now, due to: coughing, a mixture of stomach complaints, shortness of breath and loss of appetite. I am 28 years old, healthy (otherwise), with a desk job. I walk to and from work each day for 20 minutes and I don't believe I am under much stress at work. Sometimes during a stressful week I notice increased symptoms, but it's obvious that my symptoms do not disappear when I am not stressed. My GP has taken me through the following diagnoses in the past 14 months: asthma, anti-histamine, anti-biotics. For the past 6 months I have been prescribed PPI / Acid reflux medication: Pantoprazole and Esomeprazole. All of the above have seemed like they have made a difference initially, but within weeks the symptoms return, and are worse. I have asked for an "Open Referral" from my GP but am met with the response on each occasion that we should just "Try another medication". I do not believe this is making a viable difference. Which tests should I be suggesting? Is there a consultant I could suggest I am referred to for another opinion? Are there risks of one term use of the prescriptions listed above? Are there risks of allowing the coughing and nausea to continue untreated? Many thanks for any information you can provide.

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The Answer

From what you describe it is possible you have a mix of potentially two complaints, while the majority of your symptoms do seem to be relating more toward upper gastric problems such as excess acid which I see your GP has been treating you for with limited relief of your symptoms, there may possibly also be some underlying asthma well.

The types of tests that can initially be carried out would include a chest x-ray and peak flow measurements ( where you breathe out hard into a small device which then measures lung capacity) in order to aid an asthma diagnosis plus full examination of the chest with a stethoscope. Some stomach problems such as ulcers can be detected under a barium meal x ray. More commonly, apart from a thorough physical examination a gastroscopy where a flexible tube with a camera is passed into your stomach can give a good picture of any gastric problems present. Whilst there should not be any risks associated with one term use of a medication you can always discuss this with your local pharmacist. It also might be worth bearing in mind that medication is usually started at the lowest dose and can be increased to achieve better symptom relief if necessary. This may or may not be applicable to you but it may be worth discussing with your GP if a higher dose if not already in use of the PPI medications may help you.

Without a clear diagnosis it isn’t possible to know whether there are any risks attached to your unrelieved symptoms but, if your problems are not improving it does suggest that the underlying issues need more management. Overall fourteen months is quite a long time to be struggling with these symptoms and finding little relief from the medications. Under the circumstances I think it would be wise to discuss this either with the Dr you have been seeing or perhaps by speaking to another Dr at your practice for another opinion. Given the nature and length of your symptoms which seem to mainly point to a stomach problem and very possibly excess acid production, a request to see a Gastroenterology Specialist at this stage would not be unreasonable and could prove to be very helpful. In the meantime trying to avoid acid forming foods such as dairy products, rich fatty meals and spices and also reducing any alcohol and caffeine intake you may have may also help to reduce some of the symptoms.

Answered by the Health at Hand nurses  

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