GERD Symptoms: Beyond Heartburn and Bloating Issues

Gastroesophageal reflux disease (GERD) related?

Hello, doctor.
My symptoms started at the end of 2016.
I'm not sure if everyone experiences the same symptoms of gastroesophageal reflux disease (GERD).
At the end of 2016, after eating a hamburger and taking Japanese cold medicine, I felt extremely dizzy and nauseous.
Since then, for about six months, I experienced dizziness from morning until night, during which I also felt my heart beating very strongly.
Subsequent examinations only revealed GERD.
For a period, I would feel extremely dizzy after eating even a small amount, making it impossible to eat.
After about six months, the dizziness changed to only occurring until I burped.
I have also been experiencing bloating.
About six months ago, I underwent an endoscopy and after taking a proton pump inhibitor (PPI), I switched to an H2 blocker.
A week ago, after another endoscopy, the doctor said it was still GERD, but this time I also had a duodenal ulcer.
So the doctor prescribed me PPIs again.
I do not have heartburn or other symptoms associated with GERD, only bloating.
Could there be other conditions causing damage to my stomach? Do I need to undergo any additional tests?

Hulk, 30~39 year old female. Ask Date: 2020/09/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

If taking a PPI improves bloating and dizziness, it can be inferred that these symptoms may be caused by excess stomach acid.
If discomfort persists despite medication, further discussion with a physician and consideration of additional tests may be necessary.

Reply Date: 2020/09/11

More Info

Gastroesophageal reflux disease (GERD) is a common condition that can manifest in various ways, and it is essential to understand that symptoms can differ significantly from person to person. While heartburn and regurgitation are the hallmark symptoms of GERD, many individuals experience atypical symptoms that can complicate the diagnosis and management of the condition.

In your case, the symptoms you described, such as persistent dizziness, nausea, and a sensation of a strong heartbeat, are indeed concerning and warrant further exploration. It is not uncommon for GERD to present with atypical symptoms, including chest discomfort, palpitations, and even dizziness. The connection between GERD and these symptoms can be multifaceted. For instance, the irritation of the esophagus due to acid reflux can lead to a vagal response, which may cause palpitations or a sensation of dizziness. Additionally, anxiety and stress, which can be exacerbated by chronic gastrointestinal issues, may also contribute to feelings of dizziness and heart palpitations.

The fact that you experienced severe dizziness after eating and had difficulty with food intake suggests that there may be more than just GERD at play. The development of a duodenal ulcer, as noted in your recent endoscopy, can also contribute to gastrointestinal discomfort and may lead to symptoms like nausea and bloating. Ulcers can cause inflammation and irritation, which can further complicate GERD symptoms.

Given your history and the persistence of your symptoms, it would be prudent to consider additional evaluations. Here are some recommendations:
1. Gastric Emptying Study: This test can help determine if your stomach is emptying properly. Delayed gastric emptying can lead to feelings of fullness, bloating, and nausea.

2. Esophageal Manometry: This test measures the rhythmic muscle contractions in your esophagus when you swallow. It can help identify any motility disorders that may be contributing to your symptoms.

3. 24-hour pH Monitoring: This test measures acid levels in your esophagus over a 24-hour period and can help correlate your symptoms with acid reflux episodes.

4. Dietary and Lifestyle Modifications: Keeping a food diary to track what you eat and how it affects your symptoms can be beneficial. Avoiding trigger foods, eating smaller meals, and not lying down immediately after eating can help manage GERD symptoms.

5. Psychological Evaluation: Since anxiety can exacerbate gastrointestinal symptoms, it may be helpful to discuss your symptoms with a mental health professional. Cognitive-behavioral therapy (CBT) or other forms of therapy can be beneficial in managing anxiety related to chronic health issues.

6. Follow-Up with a Gastroenterologist: Regular follow-ups with your gastroenterologist are crucial, especially since you have a history of GERD and now a duodenal ulcer. They can provide tailored treatment options and monitor your condition closely.

In conclusion, while GERD is a significant factor in your symptoms, it is essential to consider other potential causes, including the possibility of a motility disorder or psychological factors. A comprehensive approach that includes further testing and lifestyle modifications may help alleviate your symptoms and improve your quality of life. Always consult with your healthcare provider before making any changes to your treatment plan.

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