Is a Gastroenterologist the next step?

My story: 5 months ago started a new job. Shortly thereafter I began to have a sensation of sandpaper in my chest at work, salty/bitter/burning mucus in abundance, sinus pressure and a barking cough with excessive throat clearing hacking. I noticed that other workers in the same environment also developed coughs and I heard that there may be poor air quality. First thing doctor tried was treatment for sinus infection. A little improvement, but it didn't stay. Allegra helped a bit and became convinced that it was some sort of allergic response to the air.

Waters View X-Ray which did not indicate infection. Next moved to a diagnosis of GERD and possible asthma. Well, silly me, because of the relief I got from Allegra I went to an Allergist for testing. Mostly negative and he put me on Zantac 150 (Problems with Nexium in the past), Singulair and MaxAir.

But, it continues to get worse. Began dieting (small meals), sleep on a slant and take the meds, but my mouth/tongue burn almost continuously along with there being a constant presence of extremely bitter mucus in the back of my throat that leads to "barking" so much that my fellow workers have expressed their annoyance quite often.

Zantac does nothing, and as far as I can tell, neither the Singulair or MaxAir inhaler. I "bark" so much that my throat gets sore and hoarse. Obviously this affects work.

Synopsis: Me - 51 years old, currently about 30 lbs overweight. Bitter, burning abundant mucus...  even just touching my throat elicits a bitter taste. A creamy white bitter coating in my throat. Barking/throat clearing cough, annoys everyone around me exhausteds me by the end of the day. A peculiar pressure in my chest. Burning tongue and mouth.

Tests: Sinus x-ray, negative. Spirometry/Nebulizer test results: 85% before, 105% after. Complete allergy regimen... slight response to the two most common molds.

Meds: Lotrel 5/20 twice a day for blood pressure, Ambien to help sleep (gets me past the cough). Singulair, Zantac & MaxAir seem useless.  What helps a little is the combination of Prilosec OTC with Axid AR (OTC). Stops cough but the bitterness/burning tongue remains, also chest irritation. Getting ready to try the Prevacid prescribed by my original.

FINALLY, MY QUESTION: I'm not convinced an Allergist is the best way to go.  WOULD IT MAKE MORE SENSE TO SEE A GASTROENTEROLOGIST INSTEAD OF A FOLLOW UP APPOINTMENT WITH AN ALLERGIST? WHAT TESTS/TREATMENT ARE THE MOST APPROPRIATE NOW? WHAT IS MOST LIKELY GOING ON?

I'm really not sure what direction to go from here, and I'm becoming concerned that my symptoms not only affect my ability to work, but even threaten my employability -  not to forget  that I'm  finding it harder and harder just to make it through the day. I cling to the hope that this  is something that is treatable.  What next?

[Kevin Pho, MD]

Yes, I would consider a GI referral.  Typically GERD, asthma and sinusitis are the most common causes of chronic cough.  Asthma medications and sinusitis treatments have not helped.  

I would consider test to definitively diagnose GERD - this can be a 24-hr pH monitor.  If there continues to be GERD despite appropriate medication, surgical options may be considered.  

In any case, a GI referral would be helpful to evaluate for GERD.  Another consideration would be an ENT physician to evaluate for sinusitis.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Biskie2]

Have you tried Actifed? It will stop the mucous from forming in your throat if it is from sinus draining, which can sometimes burn your throat.

[ESprung]

Well, a couple of days of searching has proved fruitful. So now we'll see if the answer here agrees. I've found that the symptoms of laryngopharyngeal reflux pretty much match exactly with what's going on. (It even includes post-nasal drip, which I also have).

This is a little more specialized than a Gastroenterologist. Fortunately locally we have a top notch "voice center" which includes the specialty to diagnose and treat LPR.

I originally posted my question so that I could be more focused and spend less time (and money) going to doctors... didn't want to take months and many, many appointments and follow-up appointment, and follow-ups to the follow-ups to figure it all out (if possible).

So I MIGHT have answered my own question. We'll see.