CASE PRESENTATION: A 84 year old non-smoking female presented dry cough with no dyspnoea and wheeze, fatigue and weight loss without anorexia for 2 years. She denied previous history of liver and renal disease. She referred history of rheumatoid arthritis in treatment with low dose of corticosteroid for ten years. Pulmunary function testing demonstrated a mild restrictive pattern with no significant post broncodilator respons, and methacoline airway responsiveness was normal. Skin prick tests were negative, serum total IgE was within normal limits. A high-resolution chest CT scan was performed and found nothing special. Oesophageal reflux was confirmed by 24 h manometry and pH monitoring, so she started a treatment with proton-pump inhibitors and sodium alginate. On review of 2 months lather the reflux symptoms had resolved but the cough was worse and she presented also dizziness and dyspnoea. Laboratory finding showed the hemoglobin was 52 g/l and microcytic hypocromic anemia; faecal occult blood test was positive. Ultrasonic examination of abnomen was normal. The endoscopy showed multiple foci of mucosal erosion around gastic antrum and biopsy pathology of gastric antrum was: moderate superficial crronic gastritis and extensive vasculate ectasias, that were diagnostic of GAVE syndrome. The patient had a iron supplementation and blood transfusion and after that she was admitted to hospital to underwent subtotal gastrictomy. We followed up for 6 months: the patient shoot weight, the hemoglobin was 111 g/l and chronic cought, dizziness and dyspnoea disappeared.