Persistent GERD Symptoms: Seeking Answers for Ongoing Discomfort

The symptoms of gastroesophageal reflux disease (GERD) have not improved?

Hello Doctor: Since March, I have been experiencing discomfort in my stomach.
When I am hungry, I feel a tightness and pain in my chest, and even when I am not hungry, I often feel discomfort on both sides of my chest, along with bloating and excessive stomach acid.
In June, I underwent an endoscopy, which revealed mild gastric erosion and some symptoms of gastroesophageal reflux disease (GERD).
After taking medication for the first month, I noticed that my gastrointestinal motility increased significantly, leading to a feeling of hunger shortly after eating.
During my follow-up appointment a month later, the doctor discontinued the medication that promoted gastrointestinal motility, and my symptoms returned with chest discomfort reappearing, along with an increase in stomach acid.
In the second month, when I explained my condition to the doctor, he advised me to exercise more and gradually stop taking another medication that neutralizes stomach acid and one for bloating.
Consequently, I started taking only the medication for GERD and gastric erosion, called "Weitong," in the morning.
However, my symptoms worsened; in addition to chest tightness and pain, it radiated to both sides and even to my back.
Since March, I have consistently experienced tightness and pain in my chest, but I am unsure if it is related to my stomach or GERD.
Recently, I have been experiencing excessive stomach acid every morning, a burning sensation in my throat upon waking, which sometimes lasts all day, and persistent gas that rises to my chest, making it difficult to burp.
Before bed, I often feel a rapid gastrointestinal motility and hunger, but I actually have no appetite.
I am very concerned that my gastric erosion may worsen into an ulcer or even more severe conditions like cancer.
I have a long history of anxiety disorder, which I stopped treating after starting the gastric medication.
Recently, I have been under a lot of stress and feel very tense, and I wonder if this emotional stress is contributing to my gastrointestinal discomfort.
During my follow-up visits, the doctor often thinks my issues are primarily emotional and feels that another endoscopy is unnecessary.
I would like to ask if I need to undergo another endoscopy? Why has taking "Weitong" not improved my excessive stomach acid and GERD symptoms? I sincerely request your response.
Thank you for your help!

Ms. Zhang, 40~49 year old female. Ask Date: 2020/09/05

Dr. Chen Shidian reply Gastroenterology and Hepatology

The symptoms experienced are likely caused by psychological anxiety and are unrelated to the gastroscopy.
If necessary, please seek treatment from a psychosomatic medicine specialist.

Reply Date: 2020/09/05

More Info

Persistent gastroesophageal reflux disease (GERD) symptoms can be quite distressing, and it seems you are experiencing a range of discomforts that are affecting your quality of life. GERD is a chronic condition where stomach acid flows back into the esophagus, leading to symptoms such as heartburn, chest pain, and regurgitation. Your symptoms, including chest discomfort, bloating, and increased gastric acid, suggest that your GERD may not be adequately controlled.

First, let's address your concerns regarding the potential for your gastric condition to worsen, such as developing ulcers or even cancer. While it is understandable to worry about these possibilities, it is important to note that not all cases of GERD lead to severe complications. However, untreated GERD can lead to esophagitis (inflammation of the esophagus), Barrett's esophagus (a precancerous condition), and in rare cases, esophageal cancer. Regular monitoring and appropriate treatment are crucial to prevent these outcomes.

Regarding your treatment, it appears that you have been prescribed medications to manage your GERD symptoms, including a proton pump inhibitor (PPI) like "胃通" (which I assume is a PPI). These medications are designed to reduce stomach acid production and help heal any damage to the esophagus. However, if you are still experiencing significant symptoms, it may indicate that your treatment regimen needs to be reassessed. Factors such as medication adherence, dietary habits, and lifestyle changes play a significant role in managing GERD.

You mentioned that your doctor has suggested stopping certain medications and increasing physical activity. While exercise can be beneficial for overall health and may help with some gastrointestinal symptoms, it is essential to ensure that your GERD is adequately managed first. Additionally, dietary modifications can significantly impact GERD symptoms. Common triggers include spicy foods, fatty foods, chocolate, caffeine, and alcohol. Keeping a food diary may help identify specific triggers for your symptoms.

Given your ongoing symptoms and concerns, it may be worthwhile to discuss the possibility of repeating an endoscopy (gastroscopy) with your healthcare provider. An endoscopy can provide valuable information about the state of your esophagus and stomach lining, allowing for a more tailored treatment approach. If your doctor believes that your symptoms are primarily related to anxiety, it may also be beneficial to address your mental health, as stress and anxiety can exacerbate gastrointestinal issues.

In summary, it is crucial to maintain open communication with your healthcare provider about your symptoms and concerns. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or request further evaluation, such as an endoscopy. Managing GERD often requires a multifaceted approach, including medication, lifestyle changes, and possibly addressing underlying anxiety or stress. Your health and comfort are paramount, and it is essential to advocate for yourself in your healthcare journey.

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