At 35, should I undergo a GI endoscopy for my acid reflux?

Question

Hello doctor,

I am a 35-year-old man with persistent acid reflux and throat irritation, especially after heavy meals or when lying down at night. I have been taking Pantoprazole 40 milligrams every morning for the past six months, but the burning sensation and occasional cough still occur. I have also tried elevating my bed and avoiding spicy food, but there is minimal relief. Please tell me;

Is this related to something serious like Barrett’s esophagus?
How can I confirm my condition?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You have persistent acid reflux symptoms despite six months of Pantoprazole (a type of proton pump inhibitor) 40 milligrams daily, with incomplete relief of throat irritation and burning. This could be due to several factors, including,

Proton pump inhibitor (PPI) resistance or incomplete acid suppression, which is seen in up to 30-40 percent of gastroesophageal reflux disease GERD patients on standard PPI therapy.
Barrett's esophagus, a precancerous condition, is also a concern, especially with chronic reflux symptoms.
Risk factors such as smoking and gender (it is common among men).

The prevalence in young adults is lower but not negligible. Chronic reflux damaging the esophageal lining can lead to Barrett's esophagus, which increases the risk for esophageal cancer. Upper GI (gastrointestinal) endoscopy is generally recommended in patients with typical GERD symptoms who have persistent symptoms despite a therapeutic trial of twice-daily PPI for four to eight weeks. Also, those who have alarm symptoms like

Dysphagia.
Bleeding.
Weight loss.
Anemia.

In your case, since symptoms persist after prolonged PPI use, endoscopy would be appropriate to evaluate for esophagitis, Barrett's esophagus, or other complications, as well as to rule out alternative diagnoses.

Upper GI endoscopy is indicated to assess mucosal damage and rule out Barrett's esophagus or other pathology in persistent cases despite adequate PPI therapy. Consider optimizing the PPI regimen (twice daily dosing) and clinical evaluation before endoscopy. You should consult your gastroenterologist to discuss these options and the need for upper GI endoscopy for further diagnosis and management guidance.

I hope this information helps you.

Feel free to ask further queries.

Thank you.