Why do I have upper chest and throat pain after swallowing?

Question

Hi doctor,

About three years ago, I was diagnosed with eosinophilic esophagitis (EoE), GERD (gastroesophageal reflux disease), and a hiatal hernia following an endoscopy. At the time, I was experiencing non-cardiac chest pain (all cardiac workups came back normal), occasional regurgitation, and a feeling of tightness in my upper abdomen and shoulders. A biopsy was performed during the endoscopy, which fortunately did not show any signs of metaplasia with no evidence of Barrett’s esophagus.

I was prescribed Nexpro RD 40 mg and Riflux Forte, along with strict dietary modifications to manage the GERD. These interventions worked well, as my regurgitation significantly improved, and the chest pain became much less frequent. I have continued to experience occasional tightness in my upper abdomen.

Over the past couple of days, I have started feeling pain in my upper chest and throat immediately after swallowing. I restarted Nexpro RD, which has offered some relief, but the symptoms have not fully resolved. I am starting to worry that my esophagus might be flaring up again, or worse, that I could be developing Barrett’s esophagus.

Seeing a specialist has been difficult with the ongoing COVID-19 situation. In the meantime, I would appreciate any guidance you could provide, especially around symptom management.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and understand your concern.

Based on your previous biopsy report (attachments removed to protect the patient's identity), there is no indication of eosinophilic esophagitis or Barrett’s esophagus. The report does show a sliding hiatal hernia along with significant reflux-related esophagitis. Given your history, I believe your current symptoms are most likely due to a recurrence of gastroesophageal reflux disease (GERD), which is common when medications are stopped.

Per current U.S. (United States) guidelines, a repeat endoscopy is not routinely necessary if the initial (index) endoscopy did not show Barrett’s esophagus. A follow-up scope is typically only recommended if there are red flag symptoms such as dysphagia (difficulty swallowing), unexplained weight loss, persistent vomiting, or bleeding. If you are not experiencing any of those, it is reasonable to hold off on another endoscopy for now.

I recommend restarting Nexpro RD (Esomeprazole) at 40 mg. To improve symptom control, take it twice daily, once in the morning and once about 30 minutes before dinner, for two weeks. After that, reduce the dose to once daily for another two weeks. If your symptoms resolve, consider stopping the medication and using it on an as-needed basis.

This stepped approach is consistent with how GERD is typically managed in patients without Barrett’s. The goal is effective symptom control while minimizing long-term medication use unless necessary.

Please monitor your symptoms and follow up if they worsen or do not improve with treatment.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.