Ask a doctor on the topic of General medicine

Question to Dr. Höllering!

March 28, 2017 | 20,00 EUR | answered by Dr. med. Frauke Gehring

Hello and good day Dr. Höllering,

I (male, 40 years old, non-smoker) have questions for you regarding my issue from Monday (one-time coughing up blood, no other infection or cough). The coughing up blood bothered me and I went to the hospital on Monday to have it checked out. I was there until today and wanted to ask for your advice or recommendations! The following tests were performed:

- Chest X-ray in 2 views - No findings or suspicion of a tumor
- Laryngoscopy - Clearly visible superficially vascularized vessels in the throat area and a diagnosis of laryngitis. No visible bleeding! Suspected reflux!
- Gastroscopy - Diffuse hemorrhagic gastritis but no reflux!
- Laboratory tests - Slightly elevated CRP. Otherwise unremarkable.
- Abdominal ultrasound - No findings!

Initially, a bronchoscopy was also planned, but it was no longer deemed necessary as the doctors suspect a mucosal bleeding and the X-ray was normal! I am still concerned because I have read that not everything can be seen in an X-ray. My question: Should I have insisted on a bronchoscopy or CT scan to be truly sure, or can I be somewhat reassured now?

Regarding the gastritis, I am now supposed to take Pantozol 40mg twice daily for 4 weeks, then continue with once daily. Do you have any further advice on this?

Thank you in advance.

Best regards,
Björn

Dr. med. Frauke Gehring

Good evening,

You cannot "insist" on a CT or bronchoscopy, as it is always at the discretion of the doctors whether they perform these examinations. The presence of blood in the case of laryngitis is well explained, and since the X-ray was normal, neither a CT scan (high radiation exposure) nor a bronchoscopy (anesthesia exposure) are justified here. I think it was right for the colleagues to abstain, and I would not investigate further (especially since without coughing, the blood likely came from the throat or sinus cavity).

Regarding the gastritis, I find the dosage of 2x 40 mg pantoprazole to be very high. The twice daily dosing is not necessary, as the medication works for 24 hours, and it is difficult because it only works when taken on an empty stomach (one is usually not fasting for 6 hours in the evening). I give the full daily dose in the morning, 30 minutes before breakfast.

Sincerely, Dr. Höllering