Gastroesophageal Reflux: Symptoms and When to Seek Help

Q: Gastroesophageal Reflux: Symptoms and When to Seek Help

Hello： It is recommended to consult a gastroenterologist, who can determine whether to arrange for an endoscopy. <br>This will help clearly identify the issue. <br>Additionally, please be aware of any potential weight issues that may contribute to sleep apnea. <br>Furthermore, tr

Gastroesophageal reflux disease (GERD)

Hello Doctor: Three years ago, I experienced gastroesophageal reflux and throat discomfort due to binge eating in a short period.
After undergoing an endoscopy, it was found that my esophagus had erosions, while my stomach was in good condition.
However, the muscle connecting the stomach to the esophagus was relaxed, leading to stomach acid eroding the esophagus.
The doctor prescribed "Dexilant" for me, advising to take one pill daily for six months.
After about two weeks of taking the medication, my acid reflux improved, and I stopped taking it.
For the next three years, I didn't return for a follow-up and forgot about my stomach discomfort.
Recently, in the past two months, my body has changed; I have been experiencing chest tightness and pain that radiates from the front of my chest to my back.
My breathing has become loud enough for family members to hear, and I often feel short of breath, requiring me to take deep breaths.
I wake up two to four times each night, and sometimes I suddenly feel like I'm gasping for air just as I'm falling asleep or waking up, which startles me.
There is also a foul smell reminiscent of decaying flesh.
I have minimal phlegm in my throat, but there is a significant amount of clear mucus, which often triggers a gag reflex, leading me to cough up mucus (I can cough up mucus hundreds of times a day).
Occasionally, when coughing up mucus, I expel bright red blood mixed with mucus.
I feel like there is something stuck in my throat; swallowing is not difficult, but I can sense the movement of food going down to my stomach, accompanied by a feeling of tightness, though it hasn't reached the level of pain.
My body and bowel movements are normal, my diet is regular, and I have gained weight.
I am considering seeking medical attention soon, but I would like to know how serious my current condition is so I can prepare myself.
Is esophageal cancer a concern for me? Thank you.

Nìmíng, 20~29 year old female. Ask Date: 2021/11/25

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: It is recommended to consult a gastroenterologist, who can determine whether to arrange for an endoscopy.
This will help clearly identify the issue.
Additionally, please be aware of any potential weight issues that may contribute to sleep apnea.
Furthermore, try to avoid eating for at least two hours before bedtime to prevent food or gastric acid reflux.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2021/11/25

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition where stomach acid flows back into the esophagus, leading to a variety of symptoms. Your description of symptoms, including chest pain radiating to your back, difficulty breathing, frequent waking at night, and the sensation of a lump in your throat, suggests that your condition may have worsened since your last evaluation. The presence of blood in your mucus is particularly concerning and warrants immediate medical attention.

Understanding Your Symptoms
1. Chest Pain and Back Pain: The pain you describe could be related to esophageal irritation from acid reflux. However, it can also mimic cardiac pain, which is why it’s crucial to rule out any heart-related issues. The pain radiating to your back could indicate that the esophagus is significantly irritated or that there is a more serious underlying condition.

2. Breathing Difficulties: The sensation of needing to take deep breaths and waking up gasping for air can be associated with severe reflux, especially if acid is irritating the airways or if there is a condition known as aspiration, where stomach contents enter the lungs. This can lead to chronic cough and respiratory issues.

3. Mucus and Blood: The presence of clear, sticky mucus is common in GERD, but the occurrence of blood in your mucus is alarming. This could indicate bleeding from the esophagus or throat, possibly due to severe irritation or ulceration. This symptom should be evaluated urgently.

4. Throat Sensation: The feeling of something stuck in your throat (globus sensation) is often associated with GERD. It can be exacerbated by anxiety or stress, but it’s important to ensure that there are no structural issues or malignancies.

When to Seek Help
Given your symptoms, it is essential to seek medical attention as soon as possible. Here are some reasons why:
- Worsening Symptoms: You have experienced a significant change in your symptoms, including new pain, respiratory issues, and the presence of blood. These changes indicate that your condition may have progressed and requires evaluation.

- Potential Complications: Chronic GERD can lead to complications such as esophagitis, Barrett's esophagus, and even esophageal cancer. The presence of intestinal metaplasia (as noted in your previous biopsy) is a precursor to Barrett's esophagus, which increases the risk of esophageal cancer.

- Need for Diagnostic Evaluation: You should undergo a thorough evaluation, including possibly repeating an upper endoscopy (EGD) to assess the current state of your esophagus and stomach. Additional tests, such as a barium swallow or esophageal pH monitoring, may also be warranted to assess the severity of reflux and its impact on your esophagus.

Preparing for Your Doctor's Visit
When you visit your healthcare provider, be prepared to discuss:
- The timeline and progression of your symptoms.

- Any medications you have taken and their effects.

- Your dietary habits and any recent changes in lifestyle.

- Any family history of gastrointestinal diseases or cancers.

Conclusion
Your symptoms are concerning and should not be ignored. It is crucial to seek medical attention promptly to evaluate the severity of your condition and to rule out any serious complications. Early intervention can significantly improve outcomes and quality of life. Please do not delay in making an appointment with your healthcare provider.

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