Dr. Ajeet Kumar
Medical Gastroenterology
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Patient's Query
Hello doctor,
I was diagnosed with eosinophilic esophagitis, GERD, and hiatal hernia three years back through an endoscopy. My symptoms during the period were non-cardiac chest pain (all cardiac tests were negative), infrequent regurgitation, and muscle tightness in my abdomen and shoulders. The doctor also performed a biopsy along with the endoscopy. The biopsy did not detect metaplasia. I was given Nexpro RD 40 mg and Riflux Forte for GERD. I also followed a strict diet change. These treatments significantly reduced my GERD to the point I hardly ever had a regurgitation. My chest pain also subsided. But the tightness in the upper abdomen has persisted from time to time.
For the last two days, I have been having some trouble eating. I feel pain in my upper chest and throat immediately after I swallow food. I have again started Nexpro RD, and that has provided partial relief, but these symptoms are worrying me a lot. I am concerned that my esophagus is overreacting to food and whether I am on the way to or already have developed Barrett's. Due to COVID-19, it isn't easy to get a doctor's appointment immediately, so I need help from you.
Hello,
Welcome to icliniq.com.
Well, the biopsy report (attachment removed to protect patient identity) does not show eosinophilic esophagitis, nor it showed that you have Barrett's esophagus. You have a sliding hernia and had significant reflux related esophagitis. I feel that this is again the reason for your current symptoms. The symptoms of GERD often recur if medications are stopped.
Actually, the American guidelines do not suggest repeating an endoscopy if there were no Barrett's esophagus on index endoscopy. So unless you feel that you cannot eat anything, have lost some weight, or throw up everything, you need to go for an endoscopy. Otherwise, I suggest you continue with Nexpro RD (esmaprazole) 40 mg. You can increase the dose to twice daily for two weeks. Then keep taking once daily for another two weeks and can consider stopping it and retake whenever needed. This is how GERD is managed in the absence of Barett's esophagus.
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