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As early as possible, ectopic pregnancies are treated to avoid rupture of the fallopian tube

Dear dr Roche: What is an ectopic pregnancy?

SA

“Ectopic” comes from the Greek roots meaning “out of place,” and that’s just what it is. A normal pregnancy is in the uterus (also called “womb”). The most common places for an ectopic pregnancy are along the path the ovum (egg) travels, meaning from the ovary, through the fallopian tube (which carries the ovum from the ovary to the uterus) and the uterus, and even its opening, the cervix.

Rates from 0.6% to 2% of pregnancies are reported as being ectopic. Rates are higher in Black women and women who were older when pregnant. Ninety-six percent of ectopic pregnancies are found in the fallopian tube; the ovary and the abdominal cavity are other possible sites.

There is virtually no chance for a successful ectopic pregnancy, and there’s a high risk to the mother’s life. So as early as possible, ectopic pregnancies are treated to avoid rupture of the tube. Both surgical and medical therapies are available, with medical treatment becoming the preferred treatment.

I want to emphasize this is in no way an elective abortion. The fetus cannot survive (nor be transplanted into the uterus), and the pregnancy is a risk to the mother’s life. Following treatment, even if removal of the fallopian tube is necessary, there is a good chance of preserved fertility, although the risk of a subsequent ectopic pregnancy is higher.

Dear dr Roche: I recently was diagnosed with diffuse esophageal spasm (DES). Upon initiating any meal, I begin to cough continuously. It may last for the first minute or two of the meal and then seems to subside. I do have heartburn at times as well. The doctor diagnosed DES based on my symptoms without any diagnostic testing. I have been with this physician for over 40 years. He suggested an old-school medication called Tagamet. These symptoms are embarrassing and are affecting my lifestyle. I don’t even want to sit down with family or friends to eat because of this constant initial coughing. Can you shed some information on this condition? I am a 62-year-old female. I am 125 pounds. I take losartan and a cholesterol medication. I just don’t know what to do to stop this coughing with every meal.

CP

Distal (formerly diffuse) esophageal spasm is an uncommon condition resulting from abnormal movement of the esophagus, the muscular tube that moves food from the back of the throat into the stomach. The movement is supposed to be coordinated and smooth, but in people with DES, the contractions are chaotic. The most common symptom is not cough, but difficulty swallowing and a sensation of food getting stuck (called dysphagia). Chest pain or discomfort is another common finding.

Without definitive testing (done by measuring the pressures in the esophagus), I can’t be sure you have this diagnosis. Gastroesophageal reflux disease, where stomach acid goes into the esophagus, is a much more common entity to cause heartburn and cough (this can be complicated because GERD is a common trigger for DES). A look in your esophagus and stomach with an endoscope (possible with biopsy) would be appropriate. There are several other causes of coughing with eating, including other types of swallowing problems.

Cimetidine (Tagamet) blocks some acid production and is a good (if old) treatment for GERD. It tends not to be as effective as proton pump inhibitors like omeprazole. If you aren’t getting relief, I’d recommend consultation with a gastroenterologist.

dr Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu

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