Gastric Blockage: When GERD Treatment Fails to Relieve Symptoms - Gastroenterology and Hepatology

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It sounds like you are experiencing significant discomfort and frustration with your current gastrointestinal symptoms, particularly the sensation of gastric blockage despite treatment for gastroesophageal reflux disease (GERD). Let's break down your concerns and explore the possible reasons for your symptoms, as well as the next steps you might consider.


Understanding Your Symptoms
1. Gastric Blockage Sensation: The feeling of something pressing in your stomach area, particularly between your navel and the xiphoid process (the lower part of the sternum), can be distressing. This sensation can arise from various conditions, including gastric outlet obstruction, functional dyspepsia, or even severe bloating due to gas.
2. GERD Symptoms: You mentioned that you do not experience typical GERD symptoms such as acid regurgitation, heartburn, or belching. However, GERD can present with atypical symptoms, including a sensation of fullness or pressure in the upper abdomen, which may be mistaken for gastric blockage.

3. PPI Treatment: Proton pump inhibitors (PPIs) like Dexilant (dexlansoprazole) are commonly prescribed for GERD to reduce stomach acid production. While they can be effective for many patients, they may not address all symptoms, especially if the underlying issue is not solely acid-related.

Possible Reasons for Persistent Symptoms
1. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain or discomfort in the upper abdomen without an identifiable cause. It can lead to sensations of fullness, bloating, and nausea.
2. Gastric Outlet Obstruction: Although less common, a blockage in the stomach or duodenum can lead to similar symptoms. This could be due to scarring from previous ulcers, strictures, or other anatomical issues.

3. Medication Side Effects: Some medications, including PPIs and anti-gas medications, can lead to gastrointestinal side effects, including bloating and discomfort.
4. Dietary Factors: Certain foods can exacerbate bloating and discomfort, particularly those that are high in fat, fiber, or sugar alcohols.

Next Steps
1. Follow-Up with Your Doctor: Given that your symptoms have worsened despite treatment, it is essential to follow up with your healthcare provider. They may consider additional diagnostic tests, such as an abdominal ultrasound or CT scan, to rule out any structural issues.

2. Consider a Gastroenterologist: If you feel that your current physician is not addressing your concerns adequately, it may be beneficial to seek a second opinion from a gastroenterologist. They can provide specialized insight into your symptoms and may suggest alternative treatments or diagnostic approaches.

3. Dietary Modifications: Keeping a food diary to track what you eat and how it affects your symptoms can be helpful. Avoiding known triggers, such as spicy foods, caffeine, and carbonated beverages, may provide some relief.

4. Symptom Management: In addition to PPIs, your doctor may recommend other medications to help manage symptoms, such as prokinetics to enhance gastric motility or antacids for immediate relief.

5. Lifestyle Changes: Incorporating smaller, more frequent meals, staying upright after eating, and avoiding heavy meals close to bedtime can help alleviate symptoms.


Conclusion
Your experience of gastric blockage and discomfort is valid and warrants further investigation. While GERD is a common diagnosis, the absence of classic symptoms suggests that there may be other underlying issues contributing to your discomfort. Engaging in open communication with your healthcare provider and possibly seeking a second opinion can help you find the relief you need. Remember, your health and comfort are paramount, and you deserve a treatment plan that effectively addresses your symptoms.