I am Dr. Arun and will be helping you today.
Your symptoms are suggestive of acid reflux (gastroesophageal reflux disease / GERD). This may be associated with hiatal hernia. This can cause all of your symptoms namely, chest bruise, cough, taste of bleach/chlorine, pain in chest while coughing or sneezing or laying on back.
Anti reflux therapy is;
1) antacids; Maalox
2) acid blocker; Prilosec
3) loosing weight, if overweight.
4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products
5) avoiding large meals. Eat 5 small meals in a day.
6) wait three hours after the meal before you sleep.
7) elevate head end of the bed by 8 inches.
Following also would be helpful;
1) Nux Vomica
C. Nutrition and supplements;
1) Multivitamin; vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
2) Probiotic supplement
3) Omega 3 fatty acid
4) Avoid; cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.5) Also avoid; white breads, pastas, and especially sugar, red meats,
6) Eat lean meats, cold water fish, tofu, beans, olive oil
Helpful investigations to establish and confirm the diagnosis are;
1) Esophageal manometry; evaluates esophageal motor pattern.
2) Esophagram / Barium swallow
3) Ambulatory esophageal manometry
4) CT scan of the chest.
The other possibilities of the diagnosis arel
1) Esophageal spasm
2) Esophageal motility disorder
The diagnostic and management protocol for the chronic cough is as following;
1) we will do a chest x-ray first;
2) pulmonary function tests or spirometry is the second step
3) starting of empiric therapy for postnasal drip, asthma, or gastroesophageal reflux. The GERD can be sometimes uncontrolled despite the medications and this will need further evaluation in the form of esophageal manometry (food pipe pressure study) and pH study of the food pipe (esophagus).
4) methacholine challenge testing to evaluate for airway hyperreactivity; done for the bronchospasm / bronchial asthma.
5) sputum or phlegm examination for eosinophils or empiric trial of corticosteroids for eosinophilic bronchitis.
If despite these measures, cough persists we would consider further investigations like esophagoscopy, 24-hour pH probe monitoring, high-resolution chest CT, or bronchoscopy.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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