Is upper GI endoscopy needed for persistent heartburn at 35?

Question

Hello doctor,

I am a 35-year-old man dealing with persistent heartburn and throat irritation, especially at night. I have been taking Pantoprazole 40 milligrams for months, but it does not seem to help much anymore. Please tell me;

Could I have developed resistance to PPIs (proton pump inhibitors)?
Should I get an upper GI (gastrointestinal) endoscopy to rule out something more serious like Barrett’s esophagus?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You might have experienced a partial or total lack of response to the proton pump inhibitor (PPI) like Pantoprazole, a condition referred to as PPI resistance or refractory gastroesophageal reflux disease (GERD), which affects approximately 40 percent of individuals with GERD.

This does not necessarily mean true drug resistance, but can be due to several causes, including

Incomplete acid suppression.
Non-acid reflux,
Esophageal conditions, or incorrect diagnosis of GERD.

Regarding whether you should get an upper gastrointestinal (GI) endoscopy, yes, an upper GI endoscopy is often recommended if symptoms persist despite adequate PPI therapy for eight weeks or more.

This test helps examine the esophagus, stomach, and the beginning of the small intestine to rule out complications such as

Erosive esophagitis.
Barrett’s esophagus (a precancerous condition).
Strictures, or other causes of symptoms.

Barrett’s esophagus screening is particularly considered for those with long-standing GERD symptoms unresponsive to medication, especially if risk factors like

Age over 50 years.
Male sex.
White ethnicity.
Smoking.
Family history is present.

Your age (35) is younger than the typical Barrett’s risk group, but endoscopy can still be justified if symptoms are refractory or severe. It is advisable to consult a gastroenterologist for further evaluation, which may include endoscopy, symptom reassessment, or additional diagnostic tests to clarify the cause and optimize treatment.

I hope this information helps you.

Feel free to ask further queries.

Thank you.