How to manage severe anxiety, GERD, and post-nasal drip?

Hi doctor,

I am a 36-year-old male and have a history of severe anxiety, GERD, and post-nasal drip. The GERD is usually brought on by anxiety and stress. I have recently gone through a stressful time and noticed some reflux. I have been considering going on PPI therapy again in addition to losing some weight.

I have had multiple visits with ET and two to three nasal or throat scopes over the past year and a half. I have had two esophagogastroduodenoscopies in the past eight years.

I looked in my throat and noticed at the base of my tongue there was some ‘lumpy’ looking tissue on both sides at the base of my tongue. It has made me scared and is making my anxiety worse. I think the doctor has mentioned in the past this is lymphoid tissue that can be irritated by reflux.

Because of my severe health anxiety, I would like to learn to manage this on my own and not rush to get more testing. Is it reasonable to just treat the reflux? I am just terrified this might be something more malignant, but I would like to learn to manage my anxiety. I used to take Lansoprazole in the past, which helped, but I do not like being on PPIs.

Any help or reassurance you could offer would mean a lot to me.

Thank you very much.

Hi doctor,

Thank you for the reassurance, that really means a lot. I am restarting therapy now, and will definitely be keeping up with that.

I was diagnosed by the ENT, and my upper EGD scopes actually have been relatively benign outside, with a little irritation.

I do not smoke, but I am overweight, weigh 215 pounds, and actively lose weight. This is a big goal of mine I am working on. I almost never drink alcohol, maybe a couple of times a year in a limited capacity at special events. The only signs were just my throat irritation, and I was given PPIs to take for when it flares up. It almost always correlates with my allergies or anxiety.

I also have no palpable neck nodes. I just had a recent physical consultation with normal blood work. Sometimes, when my anxiety is really bad, I get a little irritation in my throat that responds to antacids or PPIs. I try to sleep slightly elevated on my left side when this happens as well. Sometimes, it has a sour taste when the anxiety is bad. A list of other studies I have had:

1. Three times EGD in the past 15 years

2. One Barium swallow study about eight months ago showed a very slight hiatal hernia but no other symptoms or issues with the throat or upper GI tract.

5. Five nasal or larynx scopes in the past five years showed some irritation and post-nasal drip; these led to PPI therapy. It usually helps, but it also makes my anxiety worse, causes palpitations, and upsets my stomach.

Thank you again for all the help.

Hi doctor,

Thank you for your reply.

Hope all is well. Overall things have been improving, but still managing my anxiety and trying to get that under control. I was wondering if you could take a look at one more thing for me.

I was looking at the last pictures I sent you- and just wanted to make sure this also did not look too weird or suspicious. Any reassurance you could offer would mean a lot!

Thank you.