GERD: A Young Adult's Struggle with Symptoms and Treatment

Q: GERD: A Young Adult's Struggle with Symptoms and Treatment

Hello： <br>1. <br>Gastroesophageal reflux disease (GERD) may not always correlate between endoscopic findings and clinical symptoms; for instance, endoscopic grading may be A or B while symptoms are severe, and some may have endoscopic grades C or D but exhibit mild symptoms. <br

Gastroesophageal reflux is very bothersome?

Honestly, over the past six months, I've felt quite hopeless about this condition.
I'm only 24 years old and have been dealing with gastroesophageal reflux disease (GERD) since last year.
In August of last year, I underwent an endoscopy, which confirmed that the mucosa of the lower esophagus was red and inflamed.
My entire stomach and duodenum were also inflamed, but there was no Helicobacter pylori or ulcers.
The doctor prescribed NEXIUM 20 mg, and after taking it for three months, I felt 90% better.
Unfortunately, in November, after eating something spicy, my symptoms returned.

I'm not sure if my symptoms are typical, but I experience pain behind the sternum at the junction where the esophagus meets the stomach.
I don't have acid reflux reaching my throat or mouth; instead, I feel a persistent, dull pain in the center of my chest.
Lying down to sleep does not worsen the pain.
At times, even drinking water can cause burping, and I feel a burning sensation at the esophagogastric junction, although it's not very pronounced—mainly, it's the pain that bothers me.
When I'm anxious or stressed, the pain intensifies.
Drinking hot water or soup also causes discomfort in that area, and hard foods can trigger pain as well.

In November, I consulted a doctor who increased my medication to NEXIUM 40 mg.
After a few days, I felt better again, but after two weeks, I forgot to take my medication, and the next morning, I woke up with pain again.
It's incredibly frustrating! The doctor keeps referring to the results from my August endoscopy, stating that my esophagitis is mild.
They also performed a CT scan of my abdomen and blood tests for my liver, gallbladder, and pancreas, all of which came back normal.
I had a colonoscopy in August, which was also normal.

I've been very careful with my diet and have researched a lot about GERD, trying to improve my situation, but the symptoms keep recurring.
I might feel fine for a day, but then the pain returns after a couple of days, and it feels like I may never get better.
Because I'm really anxious about my condition, I went to a well-known private clinic in the north for another endoscopy, which uses the latest NBI staining and magnification techniques from Japan.
However, I felt that the consultation was not thorough, possibly due to a high volume of patients that day.
The doctor asked only a few basic questions, and after the examination, he briefly explained the findings and prescribed medication without giving me a chance to ask questions before the nurse ushered me out.

They prescribed a self-paid medication similar to NEXIUM, PANTALOC 40 mg, along with some adjunct medications to reduce gastric gas, which I understood since I had previously been prescribed similar medications.
I really hope to see my latest endoscopy report to clarify my concerns.
The report states: 1.
Larynx: No significant abnormalities.
2.
Esophagus: GERD, M-type.
3.
Stomach: a.
Superficial gastritis (erythema in the gastric fundus) b.
Moderate hiatal hernia.
4.
Duodenal bulb: No significant abnormalities; descending part: No significant abnormalities.
5.
Helicobacter pylori: Negative.

I have several questions I would like to ask the doctor: 1.
Is my condition considered mild in the eyes of a gastroenterologist? If it is indeed mild, why do I feel discomfort and pain throughout the day? 2.
Is PPI the best treatment for my condition? Why was NEXIUM 20 mg effective at first, then ineffective upon relapse, and then effective again at 40 mg for a while before becoming ineffective? Can PPIs lose their effectiveness, or should I switch between different PPIs periodically? Based on this endoscopy report, do I still need to continue PPI treatment? How long should I take PPIs? Is there a chance of complete recovery, or will I need to take medication for life? 3.
Is the inflammation in my esophagus currently mild? Is there a risk of it worsening? How far am I from developing Barrett's esophagus or esophageal cancer? 4.
Is the hiatal hernia congenital or acquired? If it is congenital, shouldn't I have experienced acid reflux and esophageal inflammation as a child? Why is the inflammation only occurring now? Could various factors have led to dysfunction of the lower esophageal sphincter, causing inflammation and pain? 5.
Aside from surgery, are there any methods, such as medications or other treatments, to address the hiatal hernia? 6.
Based on these examination results, when should I have a follow-up endoscopy?

Chen Jiaju, 20~29 year old female. Ask Date: 2013/01/13

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello:
1.
Gastroesophageal reflux disease (GERD) may not always correlate between endoscopic findings and clinical symptoms; for instance, endoscopic grading may be A or B while symptoms are severe, and some may have endoscopic grades C or D but exhibit mild symptoms.

2.
GERD is generally not easy to completely eradicate.
Proton pump inhibitors (PPIs) are effective medications for treatment, but they should be combined with dietary changes, emotional management, and lifestyle modifications.
PPIs typically need to be taken for a period of time; after symptom improvement, some may take them as needed, while others may require long-term use.
A normal diet should be maintained, with reduced intake of irritants such as tea and coffee, avoiding smoking, and managing obesity.
3.
GERD can still lead to Barrett's esophagus, which may progress to adenocarcinoma, although this is less common in Eastern populations compared to Western populations.
4.
A hiatal hernia does not necessarily cause inflammation or symptoms.
Various factors can affect sphincter dysfunction leading to inflammation, such as smoking, certain medications, obesity, and dietary habits.
Eliminating exacerbating factors and using medications (PPIs, prokinetics, mucosal protectants) can help improve symptoms.
5.
Follow-up should be conducted in 4 to 6 months.
Wishing you good health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health

Reply Date: 2013/01/13

More Info

Understanding Gastroesophageal Reflux Disease (GERD) can be quite challenging, especially for young adults like yourself who are experiencing persistent symptoms. It’s important to address your concerns systematically, as GERD can significantly impact your quality of life if not managed properly.

1. Severity of Your Condition: Based on your report, your condition is classified as mild to moderate GERD, characterized by symptoms such as esophagitis and superficial gastritis. While your doctors may consider it mild, the subjective experience of pain and discomfort you are feeling is very real and should not be dismissed. The perception of pain can vary greatly among individuals, and even mild inflammation can cause significant discomfort. It's crucial to communicate openly with your healthcare provider about the severity of your symptoms, as they may not always correlate with the findings of diagnostic tests.

2. Treatment with Proton Pump Inhibitors (PPIs): PPIs like Nexium (esomeprazole) and Pantoloc (pantoprazole) are commonly prescribed for GERD as they reduce stomach acid production, allowing healing of the esophagus. The fact that you experienced relief initially with Nexium at 20 mg but then required an increase to 40 mg suggests that your body may be developing a tolerance to the medication or that your condition may be worsening. It is not uncommon for patients to require adjustments in their medication regimen over time. Switching between different PPIs can sometimes help if one becomes less effective, but this should be done under the guidance of your physician. Long-term use of PPIs is often necessary for chronic conditions like GERD, but it is essential to have regular follow-ups to monitor your condition and adjust treatment as needed.

3. Risk of Complications: Your concern about the potential progression to Barrett's esophagus or esophageal cancer is valid, especially with ongoing symptoms. While your current findings indicate mild inflammation, chronic GERD can lead to more serious conditions over time if not managed effectively. Regular monitoring through endoscopy is recommended, especially if symptoms persist or worsen. Your healthcare provider can help determine the appropriate intervals for follow-up based on your symptoms and response to treatment.

4. Hiatal Hernia: The presence of a hiatal hernia can be a contributing factor to GERD. It can be congenital (present at birth) or acquired due to factors such as obesity, pregnancy, or age-related changes. The hernia can affect the function of the lower esophageal sphincter, leading to acid reflux. While surgery is an option for severe cases, many patients manage their symptoms effectively with lifestyle changes and medication.
5. Management Strategies: In addition to medication, lifestyle modifications can significantly impact GERD symptoms. These include avoiding trigger foods (like spicy or fatty 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.
6. Follow-Up Care: The frequency of follow-up endoscopies depends on your symptoms and the findings of your previous examinations. Typically, if you are stable and responding well to treatment, a follow-up every 1-2 years may be sufficient, but this should be tailored to your specific situation.

In conclusion, while GERD can be a frustrating and chronic condition, effective management is possible with the right combination of medication, lifestyle changes, and regular monitoring. It’s essential to maintain an open dialogue with your healthcare provider about your symptoms and treatment options to find the best approach for your situation. Remember, you are not alone in this struggle, and there are resources and strategies available to help you manage your condition effectively.

Similar Q&A

Understanding GERD vs. Acid Rebound: A Patient's Journey

Hello, Doctor: I live near Shuchang but work in Taipei, and I would like to seek your advice! In June 2016, after staying up late to play cards twice, I experienced symptoms of gastric discomfort (pain near the xiphoid process, slightly to the right), along with vomiting. I went ...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello, 1. Your symptom description indeed indicates gastroesophageal reflux disease (GERD). There is no such thing as acid rebound. You should pay attention to your diet, avoid smoking, alcohol, betel nut, tea, coffee, spicy foods, fried foods, and glutinous rice. Additionally,...

Understanding GERD: Symptoms and When to Seek Further Treatment

Hello, Doctor. About four months ago, I underwent an upper gastrointestinal endoscopy, and I was diagnosed with gastroesophageal reflux disease (GERD). I received medication for a month but did not continue to refill my prescription. Recently, I have started experiencing stomach ...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, sir. You can return for a follow-up appointment, and we can adjust your medication based on your condition. There is no need to rush into another endoscopy. Changhua Hospital cares about your health. Chen Shidian.

Managing Gastroesophageal Reflux: Symptoms, Treatment, and Weight Concerns

Hello, doctor. Two weeks ago, I experienced chest pain while eating, and after seeking medical attention and undergoing an endoscopy, I was diagnosed with gastroesophageal reflux disease (GERD) and gastritis. Currently, I am taking three medications: Esomeprazole, Domperidone, an...

Dr. Chen Shidian reply Gastroenterology and Hepatology
No need for now, maintain a normal diet, reduce sweet and acidic foods, and follow up later.

Understanding Persistent Urgency: Causes and Concerns for Young Adults

Hello Doctor, I am 19 years old and have recently been experiencing gastroesophageal reflux issues. I have been seeking medical treatment and taking medication, but since the day before yesterday, I have started to feel the urge to have a bowel movement almost all day long. When ...

Dr. Zhang Shuhao reply Surgery
It is possible to check if the medication for gastroesophageal reflux disease (GERD) is causing the symptoms, as some antacids can have a laxative effect. If an endoscopy was not performed initially, antacids are typically used as symptomatic treatment. You may try discontinuing ...