Allergy Asthma Immunol Res.  2014 Nov;6(6):573-576. 10.4168/aair.2014.6.6.573.

A Case of Chronic Cough Caused by Achalasia Misconceived as Gastroesophageal Reflux Disease

• Kwon HY
• Lim JH
• Shin YW
• Kim CW

• KMID: 2260181
• DOI: http://doi.org/10.4168/aair.2014.6.6.573

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.

Keyword

Chronic cough; achalasia; gastroesophageal reflux disease

MeSH Terms

Adult
Asthma
Cough*
Deglutition Disorders
Diagnostic Errors
Dilatation
Esophageal Achalasia*
Female
Gastroesophageal Reflux*
Humans
Outpatients
Rare Diseases

Figure

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  Fig. 1 Chest X-ray taken during the patient's first admission demonstrates opacities in the right middle lobe and right lower lobe, suggesting pneumonia (A). Chest CT taken during the second admission shows dilated esophagus with retained food materials consistent with achalasia (B), and multiple ground glass opacities on both lungs, suggesting aspiration pneumonia associated with achalasia (C).

• 

  Fig. 2 Multiple acute esophageal ulcers were noted on the first esophagogastroduodenoscopic examination for cough. This was misinterpreted as esophageal ulcers and chronic cough associated with gastroesophageal reflux disease.

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  Fig. 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).

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