At 45, what is causing my gastric reflux issues?

Hello, Doctor,

I am a 45-year-old male, 179 centimeters tall, and weigh 86 kilograms. My symptoms began around seven years back and include a constant sensation of a lump in the throat, difficulty breathing, difficulty swallowing, and a feeling that food becomes stuck while swallowing.

My general practitioner referred me to a pulmonologist, where mild bronchial hyperreactivity was identified. I was prescribed a bronchodilator, but it did not improve my symptoms. A gastroenterological evaluation, including gastroscopy, was then performed. The only abnormal finding was an approximately 4 centimeter hiatal hernia, while everything else appeared normal. An ear, nose, and throat specialist suspected reflux disease and prescribed acid-suppressing medication, but the symptoms remained unchanged.

Since then, I have undergone numerous additional examinations, including neurological evaluation, electromyography, chest and abdominal X-rays, electrocardiogram, carotid Doppler ultrasound, and cranial and abdominal computed tomography scans. All results were essentially normal except for a few diverticula and findings suggestive of irritable bowel syndrome. Despite this, the symptoms persisted. I also completed two years of psychiatric treatment with sedatives and antidepressants, but there was no significant improvement.

Two years back, due to worsening symptoms, another gastroscopy was performed. This again showed the hiatal hernia and mild gastritis, but no other significant abnormalities. Since then, I have been taking 40 milligrams of acid-suppressing medication every morning, yet the symptoms have continued to worsen. The swallowing difficulty and globus sensation have become more intense and are now associated with fullness, regurgitation, frequent belching, and shortness of breath.

Further evaluations were recommended. Allergy testing showed no confirmed allergies. Psychiatric reassessment concluded that further medication trials would likely not be beneficial because previous treatments had been ineffective.

The sensation is now almost constant and present throughout the day. Eating clearly worsens the symptoms, and even very small bites or sips trigger severe discomfort in the throat, esophagus, and chest. The most recent ear, nose, and throat examination identified irritation and inflammation at the base of the tongue, which was thought to possibly be related to laryngopharyngeal reflux and reflux disease. However, the gastroenterologist did not believe that another endoscopic examination was justified and stated that no obvious gastrointestinal disease explained the severity of the symptoms.

A neuromuscular cause has also been considered because the discomfort sometimes improves while lying down. At the same time, I have long-standing pain involving the shoulders, back, chest, and neck. Certain movements clearly worsen the throat tightness and globus sensation. An orthopedic evaluation recommended physical therapy, although no definite musculoskeletal cause was identified.

I am looking for possible explanations for these persistent and progressively worsening symptoms, including whether this could represent severe reflux-related disease, esophageal motility disorder, vagus nerve dysfunction, cricopharyngeal dysfunction, neuromuscular disease, cervical or thoracic musculoskeletal involvement, autonomic dysfunction, or another overlooked condition.

Kindly help.