Managing GERD: When to Consider Endoscopy and Continued PPI Therapy - Gastroenterology and Hepatology

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Gastroesophageal reflux disease (GERD)


In May, I underwent an upper gastrointestinal endoscopy, which revealed chronic gastritis, Helicobacter pylori infection, and gastroesophageal reflux disease (GERD).
Occasionally, I experience throat pain due to acid reflux.
The H.
pylori infection was successfully eradicated, and I have been taking proton pump inhibitors (PPIs) for about four months.
However, in the past month, my acid reflux has worsened, with symptoms of bloating and a burning sensation in my chest (which I rarely experienced before).
I also often feel pain near my sternum and ribs, especially when eating.
I consulted an otolaryngologist who performed a nasopharyngoscopy and found that my vocal cords are inflamed due to this condition.
My health insurance coverage for PPIs has recently ended after four months.
Should I undergo another endoscopy to assess my condition, and can I continue using PPIs covered by my insurance? Thank you, doctor!

ting, 20~29 year old female. Ask Date: 2023/09/25

Dr. Chen Shidian reply Gastroenterology and Hepatology


Low-dose or non-endoscopic PPI can be used under the National Health Insurance, occasionally supplemented with self-paid high-dose PPIs as needed to control symptoms.
Alternatively, a repeat endoscopy can be performed to meet the criteria for insurance-covered medications.
It is advisable to avoid foods that are low in acidity/sweetness, coffee, and glutinous rice.

Reply Date: 2023/09/25

More Info


Managing gastroesophageal reflux disease (GERD) can be quite challenging, especially when symptoms persist or worsen despite treatment. Your situation, where you have been diagnosed with chronic gastritis, Helicobacter pylori infection, and reflux esophagitis, indicates that you have a complex case that requires careful management.

First, it’s important to understand the role of proton pump inhibitors (PPIs) in treating GERD. PPIs are highly effective in reducing gastric acid production, which helps alleviate symptoms of GERD and promotes healing of the esophagus. Typically, a course of PPI therapy lasts about four to twelve months, depending on the severity of the condition and the response to treatment. In your case, you mentioned that you have been on PPIs for about four months, but your symptoms have recently worsened, leading to discomfort and pain.

Given that you are experiencing increased symptoms such as gastric bloating, chest burning, and pain near the sternum and ribs, it is advisable to consider further evaluation. Endoscopy (esophagogastroduodenoscopy or EGD) can be a valuable tool in this scenario. It allows for direct visualization of the esophagus, stomach, and duodenum, and can help identify any complications such as esophagitis, strictures, or even Barrett's esophagus, which can develop in chronic GERD cases. Since you have already undergone an endoscopy in May, it may be beneficial to have another one if your symptoms have significantly changed or worsened.

Regarding the use of PPIs, if your symptoms are severe and impacting your quality of life, it would be reasonable to discuss with your healthcare provider the possibility of continuing PPI therapy. While your initial course of treatment may have been for four months, the recurrence of symptoms could indicate that you need a longer duration of therapy. It’s also important to note that while PPIs are generally safe, long-term use can be associated with certain risks, such as nutrient malabsorption (e.g., magnesium, calcium, vitamin B12), increased risk of fractures, and potential kidney issues. However, these risks need to be weighed against the benefits of controlling your GERD symptoms.

In addition to medication, lifestyle modifications can also play a crucial role in managing GERD. These include dietary changes (avoiding trigger foods such as spicy, fatty, or acidic foods), eating smaller meals, not lying down immediately after eating, and maintaining a healthy weight. Elevating the head of your bed can also help reduce nighttime symptoms.

Lastly, since you mentioned that you have experienced throat pain and inflammation, it’s essential to address this with your healthcare provider as well. The inflammation of the vocal cords can be a result of acid reflux, and managing your GERD effectively may help alleviate this issue.

In summary, given your worsening symptoms, it is advisable to consult with your healthcare provider about the need for another endoscopy and the continuation of PPI therapy. Your treatment plan should be tailored to your specific symptoms and health status, ensuring that you receive the most effective care for your GERD.

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