Long-Term Symptoms of Gastroesophageal Reflux Disease

Long-term symptoms of gastroesophageal reflux disease (GERD)?

Hello Doctor, I am a 20-year-old male.
Last June, I was diagnosed with grade B gastroesophageal reflux disease (GERD) through an endoscopy, and I am currently undergoing treatment.
I have only been prescribed a proton pump inhibitor (PPI).
In January of this year, another endoscopy showed grade A, and the doctor mentioned that my condition has improved significantly.
However, during the treatment period, I have not experienced much relief in my stomach discomfort.

In the morning, I take the PPI and after breakfast, I feel relatively fine.
However, after lunch, I experience a sensation as if my stomach is tightening, leading to significant discomfort in the entire abdominal area, although there is no burning sensation or reflux.
After dinner in the evening, the discomfort worsens, turning into a feeling of heaviness and pain in the stomach, along with an elevated body temperature and a warm sensation in the stomach.
There is still no reflux sensation.
After taking a hot shower, the discomfort eases a bit, but I still feel a persistent dull pain until the next morning when I wake up, at which point it completely subsides.
This cycle repeats daily, and I maintain a regular eating schedule with consistent portion sizes, with symptoms consistently appearing after meals.

Yang He-Yu, 20~29 year old female. Ask Date: 2022/01/11

Dr. Hong Yuanbin reply Internal Medicine

Hello, most people's gastroesophageal reflux disease (GERD) is indeed a long-term condition caused by multiple factors, including relaxation of the lower esophageal sphincter, overeating, and lying down after meals.
Medications, including proton pump inhibitors (PPIs), are only used to alleviate symptoms and cannot completely cure the condition.
It is recommended to start by improving lifestyle habits, such as avoiding overeating, taking a short walk after meals, and eating smaller, more frequent meals.
These changes should help improve symptoms.
Thank you for your question.

Reply Date: 2022/01/11

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort. Your situation, as described, indicates a persistent struggle with GERD, even after treatment with proton pump inhibitors (PPIs). Let's break down your symptoms and treatment options, and explore some additional considerations that may help you manage your condition more effectively.

Understanding Your Symptoms
1. Postprandial Discomfort: The discomfort you experience after meals, particularly the sensation of your stomach "shrinking" or feeling tight, can be attributed to several factors. This sensation may be related to gastric motility issues, where the stomach does not empty properly, leading to feelings of fullness and discomfort. Additionally, the type of food consumed can influence gastric emptying and may exacerbate symptoms. Foods that are high in fat, spicy, or acidic can increase gastric pressure and contribute to discomfort.

2. Evening Symptoms: The worsening of symptoms after dinner, along with the feeling of heat in the stomach, could suggest that your body is struggling to digest food effectively. This could be due to a combination of factors, including the timing of your meals, the types of foods consumed, and possibly the effects of the PPI medication. It’s also worth noting that lying down after eating can exacerbate reflux symptoms, so maintaining an upright position for at least two to three hours post-meal is advisable.

3. Absence of Classic Symptoms: The lack of classic GERD symptoms such as heartburn or regurgitation does not rule out the condition. Some individuals experience atypical symptoms, including chest discomfort, nausea, or a feeling of fullness. This can sometimes complicate the diagnosis and management of GERD.

Treatment and Management Strategies
1. Continued Use of PPIs: PPIs are effective in reducing stomach acid production and can help heal the esophagus. However, they may not address all symptoms, particularly those related to gastric motility. If you have been on PPIs for an extended period without significant improvement, it may be worth discussing with your physician the possibility of adjusting your treatment plan. This could include trying different medications or adding prokinetic agents that help improve gastric emptying.

2. Dietary Modifications: Keeping a food diary can help identify any specific triggers that worsen your symptoms. Consider avoiding foods that are known to exacerbate GERD, such as:
- Fatty or fried foods
- Spicy foods
- Citrus fruits
- Chocolate
- Caffeinated beverages
- Alcohol
Instead, focus on a diet rich in whole grains, lean proteins, and non-citrus fruits and vegetables. Eating smaller, more frequent meals rather than large meals can also help reduce pressure on the stomach.

3. Lifestyle Changes: Incorporating lifestyle changes can significantly impact GERD symptoms. These include:
- Elevating the head of your bed to prevent nighttime reflux.

- Avoiding tight clothing that can put pressure on your abdomen.

- Engaging in regular physical activity, which can help improve digestion and reduce stress.

4. Regular Follow-Up: Given your ongoing symptoms, it is crucial to maintain regular follow-up appointments with your healthcare provider. They may recommend further diagnostic tests, such as esophageal pH monitoring or gastric emptying studies, to better understand your condition and tailor your treatment accordingly.

5. Stress Management: Stress can exacerbate gastrointestinal symptoms, so incorporating stress-reducing techniques such as mindfulness, yoga, or meditation may provide additional relief.

Conclusion
Your experience with GERD is not uncommon, and while PPIs are a cornerstone of treatment, they may not address all aspects of your symptoms. A comprehensive approach that includes dietary modifications, lifestyle changes, and regular medical follow-up is essential for managing your condition effectively. If your symptoms persist or worsen, do not hesitate to seek further evaluation from your healthcare provider, as they can help you navigate the complexities of GERD and improve your quality of life.

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