GERD vs. Acid Rebound: A Patient's Journey - Gastroenterology and Hepatology

Gastroesophageal reflux or acid rebound?

Hello, Doctor: I live near Shuchang but work in Taipei, and I would like to seek your advice! In June 2016, after staying up late to play cards twice, I experienced symptoms of gastric discomfort (pain near the xiphoid process, slightly to the right), along with vomiting.
I went to the hospital for an examination in mid-June, and the doctor arranged for an upper gastrointestinal endoscopy.
At the end of June, after reviewing the endoscopy report, the doctor informed me that I had redness and swelling at the gastroesophageal junction and mild gastritis.
I was prescribed two medications: Pantoprazole and Simethicone, with a continuous prescription for four months.

During my follow-up in mid-October, I informed the doctor that I frequently experienced gastric discomfort before meals and bloating pain after meals during the treatment period.
The doctor explained that this was a manifestation of gastritis.
Additionally, since Pantoprazole could no longer be prescribed continuously, I was switched to a medication called "Gastric Comfort." At the end of October, after taking Gastric Comfort for six days, I experienced significant heartburn, esophageal burning, and a sensation of something stuck in my throat (which I had never experienced in 36 years).
I self-diagnosed it as gastroesophageal reflux disease (GERD) and, after enduring it for three days, returned to the gastroenterology department.
The doctor arranged for a second upper gastrointestinal endoscopy, and the findings were similar to the first: redness and swelling at the gastroesophageal junction and mild gastritis.
I was switched back to Pantoprazole with a continuous prescription.
In early January 2017, during my follow-up, I informed the doctor that I had missed taking my medication for three days while working out of town and experienced symptoms of GERD, along with persistent gastric discomfort before meals and bloating pain after meals, which had not improved.
The doctor arranged for a third upper gastrointestinal endoscopy, and the findings were consistent with the previous two: redness and swelling at the gastroesophageal junction and mild gastritis.
I was then prescribed two new medications: "Dexpanthenol" and "Gastroesophageal Relaxant."
I would like to seek your help and knowledge on the following questions:
1.
Do I have gastroesophageal reflux disease (GERD), or have I developed rebound acid hypersecretion from long-term PPI use?
2.
Despite being particularly careful with my diet (I have researched related topics), why do I continue to experience bloating and pain after meals? Is this a side effect of the PPI?

A-Hong, 30~39 year old female. Ask Date: 2017/01/17

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello,
1.
Your symptom description indeed indicates gastroesophageal reflux disease (GERD).
There is no such thing as acid rebound.
You should pay attention to your diet, avoid smoking, alcohol, betel nut, tea, coffee, spicy foods, fried foods, and glutinous rice.
Additionally, steer clear of high-fat and high-protein foods.
Be mindful of your emotions, avoid overeating, and maintain a healthy weight without being overweight or underweight.
2.
Furthermore, monitor for symptoms of constipation or bloating, as well as whether your gastrointestinal motility is too fast or too slow, as these can affect gastric emptying time.
In certain cases, this may be caused by gastroparesis, which is not likely a side effect of medication.
If your symptoms do not improve, you should consult a gastroenterologist again.
Changhua Hospital cares about your health.

Dr.
Tsai An-shun

Reply Date: 2017/01/17

More Info

Understanding GERD (Gastroesophageal Reflux Disease) and acid rebound can be quite complex, especially for patients who have been on long-term proton pump inhibitors (PPIs) like Pantoprazole (耐適恩) or Esomeprazole (胃樂順). Your journey through various treatments and symptoms is not uncommon, and it raises important questions about the nature of your condition and the medications you are taking.

1. Are you experiencing GERD or acid rebound?
Based on your symptoms of chest discomfort, nausea, and the sensation of acid reflux, it is likely that you are experiencing GERD. GERD is characterized by the backward flow of stomach acid into the esophagus, which can lead to symptoms such as heartburn, regurgitation, and discomfort in the chest or throat. The inflammation of the gastroesophageal junction (the area where the esophagus meets the stomach) that was noted in your endoscopy reports suggests that there is indeed some degree of reflux occurring.

On the other hand, acid rebound is a phenomenon that can occur after discontinuing PPIs. When these medications are taken for an extended period, the body may adapt by increasing gastric acid production. If you suddenly stop taking PPIs, you might experience an increase in acid production, leading to symptoms similar to those of GERD. This could explain the discomfort you felt during the days you were not on medication.

2. Why do you experience post-meal bloating and pain?
The bloating and pain after meals can be attributed to several factors. First, while PPIs are effective at reducing stomach acid, they can also affect the digestive process. A reduction in stomach acid can impair the digestion of food, leading to bloating and discomfort. Additionally, if you have been diagnosed with gastritis (inflammation of the stomach lining), this condition can also contribute to postprandial (after eating) discomfort.

It is also essential to consider dietary factors. Even with careful dietary management, certain foods can still trigger symptoms. Common culprits include spicy foods, fatty foods, caffeine, and carbonated beverages. If you are experiencing persistent bloating, it may be beneficial to keep a food diary to identify any specific triggers.

3. What should you do next?
Given your ongoing symptoms and the complexity of your situation, it is crucial to maintain open communication with your healthcare provider. Here are some steps you might consider:
- Follow-Up Appointment: Schedule a follow-up appointment with your gastroenterologist to discuss your symptoms in detail. It may be necessary to adjust your medication regimen or explore alternative treatments.

- Medication Review: Discuss the possibility of switching to a different class of medications or adjusting the dosage of your current PPIs. Sometimes, a lower dose or a different medication may alleviate symptoms without causing rebound effects.

- Lifestyle Modifications: Continue to focus on dietary changes and lifestyle modifications. Eating smaller, more frequent meals, avoiding late-night eating, and maintaining an upright position after meals can help reduce symptoms.

- Consider Testing: If symptoms persist, your doctor may recommend additional testing, such as a pH monitoring study, to assess the acid levels in your esophagus and determine the severity of reflux.

In summary, your symptoms suggest that you may be experiencing GERD, potentially exacerbated by long-term PPI use. It is essential to work closely with your healthcare provider to find the most effective treatment plan tailored to your needs. Remember, managing GERD often requires a multifaceted approach that includes medication, dietary changes, and lifestyle adjustments.

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