Puzzled, need help and your suggestions

[weiwei]

I, 35 female was diagonosed as Gerd 5 months ago by primary doctor and took 4 months Protonix. At the beginning, Protonix really helped reduce the chest pain, but then several months, my symtom kept the same, no much improvement, at the same time I felt dizzy or light-headed. I stopped taking Protonix for 20 days,Then I changed to Nexium two weeks ago,I felt it helps and I don't feel dizzy any more. Now what I felt is still a little pain in my esphagas sometimes, esp at night or  3 hours after big meal. And Sometimes in the cold morning.

At the same time, I was told by Primary Doctor to see a GI who ordered me an endoscope.

I took the endoscope last week and the GI dr said he didn't see anything wrong. He said he didn't think it is acid reflex, he said I shouldn't have acid after taking 10 days nexium,there is no acid in my stomach and if it is Acid reflux, some patients recovered 3 days. I asked then what it is, the dr said he doesn't know he will ask my primary dr's opinion. I felt more puzzled. And I doubt what he said after learning about Gerd for 5 months.

By the way,I also have ruled out heart problem before I was diogonosed as Gerd.
I was puzzled by the GI dr. Any ideas and suggestions would be appreciated.

[Kevin Pho, MD]

Hello - thanks for asking your question.

There are many causes of pain in the esophagus.  One of them is dyspepsia.  Dyspepsia was defined as pain or discomfort centered in the upper abdomen.  Dyspepsia can be intermittent or continuous, and may or may not be related to meals.

There are four major causes of dyspepsia: nonulcer dyspepsia,  
gastroesophageal reflux disease (GERD)/esophagitis,  
peptic ulcer disease (gastric or duodenal), and gastric cancer.
In studies of dyspeptic patients who undergo endoscopy, no abnormality is detected in ~60% of patients. By definition, the diagnosis of dyspeptic patients without a structural abnormality (usually documented by upper endoscopy) is nonulcer dyspepsia (also referred to as functional dyspepsia).
  
The three main structural abnormalities typical of dyspepsia are esophagitis (15%), peptic ulcer disease(20%), and gastric cancer (<1%). A small proportion of patients will have gastric or duodenal erosions of uncertain relationship to their symptoms. Also, some patients with normal endoscopy undoubtedly have gastroesophageal reflux disease (GERD). Nonetheless, clearly the majority of patients who present with dyspepsia without alarm features will have no detectable organic disease.
  
Hiatal hernia may be uncovered during the evaluation. Hiatal hernia is considered a contributing factor, but not a causative one. The presence of a hiatal hernia does not mean that GERD is present, but it should raise one's suspicions, especially in those patients who report heartburn or acid regurgitation.

Here are some lesser-known causes of dyspepsia:
Biliary disease  
Pancreatitis  
Irritable bowel disease  
Ischemic bowel disease  
Gastroparesis  
Drugs (i.e., NSAIDs, iron, potassium supplements, bisphosphonates, antibiotics)  
Ischemic heart disease  

I stress that this answer is not intended as and does not substitute for medical advice - please see your primary care physician for further evaluation of your individual case.
  
Thanks,      
Kevin, M.D.

[ozark]

hi   i was diagnosed with nonerosive acid reflux...my endoscopy showed nothing abnormal but my ph probe showed fairly moderate reflux especially at night so maybe you should have a ph probe done to rule it out altogether...good luck