How can a male manage persistent acid reflux at age 24?

Question

Hello doctor,

I’m a 24-year-old male and have been having issues with my oesophagus for about 10 months on and off. I have constant acid reflux and these drugs did not help: Omeprazole, Pantoprazole, Buspirone, Voquezna, Ondansetron, and a 10 day course of Dexamethasone.

I can't do any sort of physical exertion, or even go to some places without my stomach revolting. I start to feel dizzy, sick and weak for no apparent reason and no warning. This has nearly made me a prisoner in my own house.

I’ve had a CT scan of my brain, gallstones ultrasound, 2 endoscopies, one with a Bravo device, gastric emptying study and a barium swallow test. Everything was completely normal, or negative for anything significant.

I have tried strict dietary changes and there has been no improvement. On the advice of a doctor I tried cannabis too but this did not help. Barrett’s oesophagus and eosinophilic oesophagitis have been ruled out.

I am running out of options and my doctors still can't figure out what is wrong.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have looked at your query and I understand your concern.

The reflux symptoms are chronic and unresponsive. Extensive GI (gastrointestinal) testing and neurological testing has come back normal. You have had two endoscopies with a Bravo pH study (a minimally invasive, wireless, 48 to 96-hour procedure used to diagnose gastro-oesophageal reflux disease), gastric emptying and imaging.

This opens up the possibility of a functional gastrointestinal disorder, such as functional heartburn or reflux hypersensitivity, both of which are characterised by esophageal sensitivity in the absence of a structural disease. Often these conditions do not respond to acid suppression therapy alone. They may require a neuromodulatory approach (therapeutic techniques that use electrical, chemical or magnetic stimulation to change nervous system activity) targeting the brain-gut axis.

You may be offered low-dose tricyclic antidepressants such as Nortriptyline or Amitriptyline or SNRIs (serotonin-norepinephrine reuptake inhibitors) such as Duloxetine which have been shown to reduce esophageal hypersensitivity and visceral pain.

The physical intolerance and post-exertional malaise you described also raise suspicion for autonomic dysfunction (e.g. POTS, postural orthostatic tachycardia syndrome, which is characterised by an excessively large increase in heart rate when sitting up or standing) that can occur alongside GI issues and cause symptoms of dizziness, nausea, weakness, and fatigue with activity. A tilt table test or an active stand test might be useful in evaluating that possibility.

If anxiety or somatic symptom amplification is contributing to the problem, working with a GI psychologist trained in gut-directed cognitive behavioural therapy (CBT) can be very helpful.

It is important to involve a multidisciplinary team, including a gastroenterologist who has experience with functional esophageal disorders, a neurologist with expertise in dysautonomia (a nervous system disorder that affects autonomic body processes) and, if appropriate, a pain or psychosomatic medicine specialist.

Keep looking for answers, you are on the right track. This is a profound limiting condition; but therapeutic opportunities still exist beyond traditional acid suppression.

I hope this is helpful in answering your question.

Let me know if I can help you any further.

Thank you.