Sofia is 38 years old. She has had symptoms of heartburn since she was 25 years old. Initially, she had heartburn twice a month but now she has heartburn almost every day. She saw her primary care physician 5 years ago for the heartburn. She was given ranitidine once a day. A few months later, the dose was increased to twice a day. She was referred to a gastroenterologist. The GI physician discontinued the ranitidine and started omeprazole 40 mg once a day. An esophagogastroduodenoscopy (EGD) also known as upper endoscopy was done. The EGD was normal. Biopsies from the esophagus were normal.
What are the causes of heartburn
- Gastroesophageal reflux disease.
- Eosinophilic esophagitis.
- Infectious esophagitis.
- Radiation esophagitis.
- Pill esophagitis.
- Esophageal obstruction.
- Esophageal cancer.
- Rumination syndrome.
- Functional heartburn.
Is it acid reflux?
Sofia was surprised her upper endoscopy was normal. “What do I do?” she asked her doctor. Her symptoms persisted. She was told to increase her omeprazole to twice a day before meals. She complied. But her symptoms persisted. Therefore, her doctor ordered a Bravo PH study off therapy. Also, she had an esophageal manometry.
She did not have acid reflux. Her esophageal manometry was normal.
She was diagnosed with functional heartburn. A prescription for citalopram 20mg daily was given. Two months later, she felt better.
What are the symptoms of acid reflux?
- Chest pain.
- Difficulty swallowing.
- Globus sensation.
- Water brash or hypersalivation.
- Hoarseness of voice.
How to treat acid reflux
- Avoid certain foods and drinks like alcohol, chocolate, peppermint, tomatoes, peppers, spearmint, caffeine, fatty foods and citrus fruits.
- Discuss your medications with your doctors. Some medications make your symptoms worse.
- Lose weight.
- Avoid tobacco.
- Wait for 2-3 hours after dinner before going to bed.
- Raise the head of bed by 6-8 inches.
- Use medications as prescribed. Proton pump inhibitors work better before food.
- Follow all other recommendations by your physician.
Is it acid reflux?
If your symptoms are not responding to treatment, do you really have acid reflux? Confirm if you have acid reflux with an upper endoscopy, 24 hour PH study or Bravo PH study. If you don’t have acid reflux, then what do you have? You will need an esophageal manometry to exclude achalasia, scleroderma, and other motility disorders. You may need a gastric emptying study to exclude gastroparesis.
Keep in mind that you can have acid reflux and a seperate disease that make your symptoms worse. Diseases that can make acid reflux symptoms worse are motility disorders and gastroparesis.
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