Hiatal hernia associated chronic cough: two case reports

Chronic cough conventionally defined as a cough persisting for more than 8 weeks, represents both a disabling symptom for the patients and a difficult management problem. Gastroesophageal reflux alone or in combination with other factors such as postnasal drip syndrome and/or asthma is the cause of chronic cough in 10-40 % of adult patients. Reflux related extraoesophageal manifestations are frequent and represent a diagnostic and therapeutic challenge which could involve lungs, upper airways and mouth, presenting with asthma, laryngitis, chronic cough, dental erosions, and non-cardiac chest pain. One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. Here we present two patients with chronic cough, who had hiatal hernia. The first case is an 81-year-old male, with a cough for the last three years. The patient had been visiting pulmonologists for a long time because of their cough. Finally, he was instructed to consult a gastroenterologist. In the upper endoscopy, in addition to antral gastritis suspicious for an intestinal metaplasia, there was also a 3-4 cm hiatal hernia. Whereas the second case is a 54-year-old lady with chronic cough. She also has been visited many times by doctors. Endoscopy revealed hiatal hernia of 4-5 cm. Despite the prescribed therapies and diet the cough persisted, therefore laparoscopic fundoplication was proposed. At the end of this report, it should be said that in the differential diagnosis of a chronic cough, gastroesophageal reflux disease should also be considered

Clostridium difficile infection following standard triple therapy for H. pylori eradication : a report of 3 cases

Introduction/Aim: Even though it is not known how much resistance to clarithromycin is in our country, the therapy of choice for eradicating H. pylori continues to be the clarithromycin-based triple therapy. This 14-day therapy is generally well tolerated, with rare cases of mild side effects. However, although rarely in the literature, there are cases with severe side effects with pseudomembranous colitis. Infection with C. difficile causes a spectrum of diseases ranging from occasional diarrhoea to colitis, toxic megacolon, and death. Here we have presented three cases of C. difficile infection that appeared after eradication therapy with clarithromycin-based triple therapy. After therapy with oral vancomycin, the diarrhoea stopped completely. Presentation of cases: Case 1. A.B. 36-year-old female, reported due to frequent bowel movements, one month after receiving the two-week eradication therapy with clarithromycin, amoxicillin and pantoprazole. Lactose intolerance was suspected, but the genetic test for lactose intolerance was negative. After C. difficile toxin A and B were positive, a 14-day therapy with oral vancomycin 4x125 mg was prescribed. After 10 days, the stools stopped completely. Case 2. B.B. 38-year-old male. Reported due to frequent stools three weeks after completion of eradication therapy with clarithromycin. Oral vancomycin 4x125mg was prescribed for 14 days. On the tenth day, stools stopped, and faeces began to form. Case 3. G.Z. 25-year-old male. Three months after the end of eradication therapy, watery, bloodless stools appeared. Since C. difficile toxin A and B were positive, he was prescribed oral therapy with vancomycin 4x125 mg for 14 days. Towards the seventh day, the diaries left the terrace. In all three cases, control tests for C. difficile toxin A and B were negative. Colonoscopy was not performed on any of the patients, since such a thing is not mandatory. Diagnosis is made only by tests of toxins A and B in faeces and not by culture. Conclusion: These cases suggest that our doctors should have a high index of suspicion for pseudomembranous colitis in patients with diarrhoea after H. pylori eradication