and Managing Gastroesophageal Reflux Disease Symptoms

Gastroesophageal reflux disease (GERD)

Hello Doctor, last November I went to a hospital in Zhongli for an endoscopy due to frequent stomach pain and symptoms of gastroesophageal reflux disease (GERD).
The doctor said that both my stomach and esophagus looked normal and there were no signs of GERD.
However, I continued to feel discomfort in my stomach, had a lot of phlegm, a sensation of a foreign body in my throat, chest pain and tightness, and sometimes acidic fluid would come up from my throat.
In April of this year, I had a nasal endoscopy at Chang Gung Hospital, where the doctor said my throat was fine but that I had GERD and advised me to see a hepatobiliary and gastroenterology specialist.
I returned to the original doctor to discuss my symptoms, and he said, "No issues with your throat means there's no cancer!" He also mentioned, "I did an endoscopy last November, and everything was fine! Your stomach and esophagus are normal!" So he only prescribed some medication for gastric ulcers.

In the following months, due to some family issues causing me a lot of stress, my stomach discomfort worsened, I had more phlegm, and my stomach felt bloated.
Drinking water made me burp continuously, and my heart would race and tremble.
I consulted a cardiologist, and everything was normal.
Later, I experienced severe throat pain and persistent coughing, so I saw an ENT specialist.
When the doctor cleared my throat, I vomited stomach acid.
The ENT doctor said, "Your GERD is very severe and needs to be addressed first!"
I then returned to the doctor who performed my endoscopy and told him about my acid reflux, the sensation of food being stuck in my throat, constant coughing, excessive phlegm, and continuous burping after drinking water.
He surprisingly said, "Why are you burping? I've never heard of burping from drinking water! I did an endoscopy last November, and your stomach and esophagus were very good! The esophagus has a high acid tolerance! Who says your GERD is severe? How can you say it's not just a cold? If you insist on another endoscopy, I won't oppose it! But the results will definitely be the same.
I'll prescribe you another month of medication for GERD and to prevent burping." I asked, "What if it doesn't improve?" The doctor replied, "Then go see a psychiatrist."
Doctor, do I need to go to another hospital for an endoscopy to check my GERD symptoms? I really don't know where to go in Zhongli for my GERD symptoms.
Has that doctor delayed my treatment? Thank you for your response.

Xiao Xiong, 40~49 year old female. Ask Date: 2017/06/21

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, it is highly likely to be NERD (Non-Erosive Reflux Disease), which involves gastroesophageal reflux, but the endoscopy does not show any changes indicative of reflux esophagitis.

Reply Date: 2017/06/21

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition that occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort in the chest or throat. Your experience highlights a common challenge faced by many patients with GERD: the difficulty in obtaining a clear diagnosis and effective treatment, especially when symptoms persist despite previous evaluations.

From your description, it seems that you have been experiencing a range of symptoms, including throat discomfort, excessive phlegm, chest pain, and a sensation of food being stuck in your throat. These symptoms can indeed be indicative of GERD, even if initial endoscopic examinations did not reveal significant abnormalities. It's important to note that GERD can sometimes be present without visible damage to the esophagus, especially in its early stages or in cases of functional GERD, where the esophagus may be hypersensitive to acid.

The fact that your symptoms have worsened over time, particularly with increased stress, suggests that there may be a multifactorial component to your condition. Stress can exacerbate gastrointestinal symptoms, and it is not uncommon for patients to experience heightened sensitivity to reflux during stressful periods. Additionally, the presence of throat pain and cough could indicate laryngopharyngeal reflux (LPR), a condition where stomach acid reaches the throat and voice box, leading to irritation.

Regarding your concerns about the physician's response and the adequacy of your treatment, it is crucial to advocate for your health. If you feel that your symptoms are not being adequately addressed, seeking a second opinion is a reasonable course of action. A different gastroenterologist may provide a fresh perspective and potentially recommend further diagnostic tests, such as a 24-hour pH monitoring study or esophageal manometry, which can assess acid exposure and esophageal motility, respectively.

In terms of management, proton pump inhibitors (PPIs) are often the first-line treatment for GERD, as they effectively reduce stomach acid production. However, if you find that your symptoms persist despite medication, it may be worth discussing alternative treatment options with a new physician. Lifestyle modifications, such as dietary changes, weight management, and avoiding triggers (like certain foods, caffeine, and alcohol), can also play a significant role in managing GERD symptoms.

Additionally, if you are experiencing significant anxiety or stress related to your symptoms, it may be beneficial to consider counseling or therapy as part of your treatment plan. Mental health can significantly impact gastrointestinal health, and addressing any underlying anxiety may help alleviate some of your physical symptoms.

In conclusion, it is essential to continue seeking care until you find a treatment plan that effectively addresses your symptoms. If you feel that your current physician is not taking your concerns seriously, do not hesitate to seek a second opinion from another gastroenterologist. Your health and comfort are paramount, and you deserve a thorough evaluation and a treatment plan that works for you.

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