Gastroesophageal Reflux: Symptoms and Treatment Options - Gastroenterology and Hepatology

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Gastroesophageal reflux disease (GERD)


Hello, Doctor: Earlier this year, I underwent an endoscopy due to symptoms of gastroesophageal reflux disease (GERD).
The esophagus showed some discoloration, but it wasn't severe, so I didn't pay much attention to it.
Last month, I suddenly experienced a burning sensation in my stomach, without the typical heartburn.
I went for another endoscopy and was diagnosed with mild esophagitis, classified as Grade A.
The doctor prescribed Nexium, along with two other medications to relieve bloating and promote gastric emptying.
After taking these medications for over two weeks, I have seen no improvement.

My condition is that I have never felt acid reflux, but whenever I sit in a regular chair with my back against the backrest, regardless of whether my stomach is empty or full, I experience a burning sensation in my stomach.
It's even worse when lying down.
Standing up feels completely normal.
When I mentioned this to the doctor, he said my condition isn't severe, just mild esophagitis.
However, this is my situation: whenever I try to rest against a chair or lie down, I experience stomach burning, sometimes accompanied by spasms.
It's driving me crazy; I even hug my stomach while sleeping and need to take sleeping pills.

Doctor, have you encountered this kind of situation before? What should I do?

Niming, 50~59 year old female. Ask Date: 2020/11/21

Dr. Cai Anshun reply Gastroenterology and Hepatology


Hello: The burning sensation is likely related to issues with stomach acid production.
As for whether it may be accompanied by other problems, adjustments to medication, diet, body posture, mental stress (including insomnia), or constipation, as well as gastrointestinal motility disorders, could all potentially contribute to the symptoms.
It is recommended to consult a gastroenterologist for a more detailed discussion with a clinician regarding the underlying causes.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2020/11/21

More Info


Gastroesophageal reflux disease (GERD) is a common condition characterized by the backward flow of stomach contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort. Your situation, as described, indicates that you have been diagnosed with mild esophagitis and have been prescribed medications to alleviate your symptoms. However, it seems that despite treatment, you continue to experience significant discomfort, particularly when sitting or lying down.


Understanding Your Symptoms
1. Esophageal Sensitivity: The burning sensation you experience when sitting or lying down could be due to increased sensitivity of the esophagus. This can occur even in the absence of significant acid reflux. The esophagus can become inflamed or irritated, leading to discomfort when pressure is applied, such as when leaning back in a chair or lying down.

2. Positioning: Certain positions can exacerbate GERD symptoms. When you lean back, gravity may not help keep stomach contents down, leading to discomfort. Standing or sitting upright can often alleviate symptoms because it uses gravity to keep the stomach contents in place.

3. Medication Response: You mentioned that you have been on medication for over two weeks without improvement. Proton pump inhibitors (PPIs) like Nexium (Esomeprazole) are typically effective for reducing stomach acid production and healing esophagitis. However, it may take several weeks for the full effect to be felt, and some patients may require a higher dose or additional medications to manage their symptoms effectively.


Recommendations for Management
1. Dietary Modifications: Consider keeping a food diary to identify any potential triggers that may exacerbate your symptoms. Common culprits include spicy foods, fatty foods, chocolate, caffeine, and acidic foods. Reducing or eliminating these from your diet may help.

2. Lifestyle Changes:
- Eating Habits: Eat smaller, more frequent meals rather than large meals. Avoid eating close to bedtime, as lying down after eating can trigger reflux.

- Weight Management: If applicable, maintaining a healthy weight can reduce pressure on the stomach and lower the risk of reflux.

- Elevate the Head of Your Bed: Sleeping with your head elevated can help prevent nighttime symptoms.

3. Medication Review: If your symptoms persist despite lifestyle changes and medication, it may be worthwhile to revisit your healthcare provider. They may consider adjusting your medication regimen or exploring other options, such as adding prokinetic agents that help with gastric emptying.

4. Further Evaluation: If symptoms continue to be severe, further evaluation may be necessary. This could include a 24-hour pH monitoring study to assess acid exposure in the esophagus or esophageal motility studies to evaluate how well the esophagus is functioning.

5. Stress Management: Since you mentioned needing sleep aids, consider incorporating stress-reducing techniques such as mindfulness, yoga, or cognitive behavioral therapy. Stress can exacerbate gastrointestinal symptoms, and managing it may provide some relief.


Conclusion
Your symptoms are indeed concerning and warrant further attention. While GERD can often be managed effectively with lifestyle changes and medications, persistent symptoms like yours should be thoroughly evaluated. It is essential to maintain open communication with your healthcare provider about your ongoing discomfort and any changes in your symptoms. They can help tailor a treatment plan that addresses your specific needs and improves your quality of life.

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