Gastroesophageal Reflux: When to Seek Further Evaluation

Severe discomfort in the stomach?

Hello Doctor, I would like to ask you about my condition.
In July of this year, I experienced discomfort in my stomach and underwent an endoscopy, which diagnosed me with mild gastroesophageal reflux disease (GERD) and gastritis.
After taking medication for four months, it seemed to have resolved, so I stopped taking the medication.
However, in December, after catching a cold, my stomach discomfort returned, and this time it was more severe, with symptoms including chest tightness, bloating, belching, and gastric pressure pain.
I visited a clinic, and they diagnosed me with GERD again and prescribed medication.
After taking the medication, my bloating and belching improved, but the chest tightness and gastric pressure pain persisted.
Eventually, the chest tightness became unbearable, and I went to a large hospital's emergency department for treatment, which alleviated the tightness.
During the emergency visit, I had an electrocardiogram, chest X-ray, and blood tests, all of which showed no abnormalities.
They suggested that my chest tightness was likely caused by GERD and prescribed medication again.
Currently, my symptoms of chest tightness, bloating, and belching have resolved, but I still experience gastric pressure pain, and I feel acid reflux when I sleep (which I did not experience before).
Should I consider having another endoscopy? Is there a possibility that something serious has developed in my stomach in such a short time, causing this discomfort? Thank you for your response, Doctor!

Saku, 30~39 year old female. Ask Date: 2016/12/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, it appears to be a worsening of gastroesophageal reflux disease (GERD).
It is recommended to undergo another endoscopy.

Reply Date: 2016/12/12

More Info

Gastroesophageal reflux disease (GERD) is a common condition that can lead to various symptoms, including heartburn, regurgitation, chest discomfort, and abdominal pain. Your recent experiences with worsening symptoms, particularly after a respiratory illness, highlight the importance of monitoring and managing GERD effectively.
Given your history of mild GERD and gastritis, along with the recent exacerbation of symptoms, it is understandable to be concerned about the possibility of complications or the development of new issues within a short time frame. The symptoms you describe—chest tightness, abdominal discomfort, and acid regurgitation—can indeed be distressing and may warrant further evaluation.

1. When to Seek Further Evaluation: It is generally advisable to seek further evaluation if you experience persistent or worsening symptoms, especially if they interfere with your daily life or sleep. In your case, the return of acid reflux symptoms, particularly the sensation of acid coming up while sleeping, is a significant change that should not be ignored. Additionally, the fact that you experienced chest tightness severe enough to warrant an emergency room visit suggests that further investigation is prudent.

2. Potential for Complications: While it is unlikely that significant changes, such as malignancy, would develop in such a short period, the presence of ongoing symptoms like gastric pain and acid reflux can indicate that your GERD is not well-controlled. Chronic inflammation from GERD can lead to complications such as esophagitis, Barrett's esophagus, or even strictures over time. Therefore, a repeat endoscopy may be warranted to assess the state of your esophagus and stomach lining, especially since you have experienced a change in your symptoms.

3. Endoscopy Considerations: An upper gastrointestinal endoscopy (EGD) can provide valuable information about the condition of your esophagus and stomach. It allows for direct visualization of any inflammation, ulcers, or other abnormalities. Given your history of gastritis and the recent exacerbation of symptoms, an endoscopy could help rule out any serious conditions and guide appropriate treatment.
4. Management and Medication: Since you have already been on proton pump inhibitors (PPIs) and have seen some improvement in certain symptoms, it may be beneficial to continue or adjust your medication under the guidance of your healthcare provider. PPIs are effective in reducing stomach acid production and can help heal the esophagus and stomach lining. However, they should be used judiciously, especially considering your concerns about calcium absorption and osteoporosis.

5. Lifestyle Modifications: In addition to medication, lifestyle modifications can play a crucial role in managing GERD. These include dietary changes (avoiding trigger foods), weight management, elevating the head of the bed, and avoiding late-night meals. Keeping a symptom diary can also help identify specific triggers that exacerbate your condition.

In conclusion, given your current symptoms and the changes you've experienced, it would be wise to consult with your gastroenterologist about the possibility of undergoing another endoscopy. This will help ensure that any underlying issues are addressed and that you receive the most appropriate treatment for your condition. Your health and comfort are paramount, and proactive management is key to preventing complications associated with GERD.

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