Reflux with no symptoms/esophagitis

[beth0277]

Last year I (27 y.o) had an Upper GI due to an upset stomach, which was from starting an SSRI and went away quickly. During the test, a small amount of reflux was found, which surprised me since I have never felt heartburn. I have also never had any throat problems, coughing, pain or any other symptoms. My dr was not concerned. I read about silent reflux and was worried about Barrett's, so I asked for a referral to a GI. In September of this year (13 months after my Upper GI), I was given an endoscopy which found what my GI doctor called Garden Variety Esophagitis she believed caused by acid reflux. She noted inflammation and ulcerations. The only change that happened in those 13 months was that I had excessive snoring. I had also started taking Trimethoprim at bedtime 3 days prior to my endoscopy. My GI was not extremely worried and placed me on Dexilant 60 mg/day. I was told to take it for 3 months and then do a Barium Swallow and if it was clear, get off the Dexilant. I expressed concern for the Esophagitis returning since I had absolutely no symptoms in the first place. She said that after I am off of the PPI for 3 months, we will do an endoscopy to check for any damage and if any is found, we will do a PPI long term. I had my Barium Swallow this week. I was told it was "normal" and to stop taking my Dexilant until I get my Endoscopy in a few months. The report said "Minimal amount of reflux in the supine position which was not able to be duplicated". My questions are: 1) Is it normal to have reflux if you are on PPI treatment, which I still was at the time of the Barium Swallow? I did not think I should be having any reflux since I was on the medicine. 2) What course of treatment is typically suggested for a patient like me? I feel lost since I can't feel ANYTHING from the acid reflux and Esophagitis. 3) Would long term PPI treatment typically be enough to prevent Esophagitis, and in addition, Barrett's Esophagus?

[Vaibhav Banait, MD]

Dear beth0277,

Thanks for posting your query.

I have gone through the details that you have provided. I would answer your queries one by one.

1) Is it normal to have reflux if you are on PPI treatment, which I still was at the time of the Barium Swallow? I did not think I should be having any reflux since I was on the medicine.

You seem to be having mild reflux which is physiological (normal) in your case and is not a cause for concern. Such mild reflux can occur even when you are on the PPI treatment.

2) What course of treatment is typically suggested for a patient like me? I feel lost since I can't feel ANYTHING from the acid reflux and Esophagitis.

Fortunately, your barium study is normal and so there is no need for aggressive intervention. The main cause of your problem might be the weight that you have gained.  I would suggest the following which will help you.
1. Try and reduce your weight by following an appropriate diet and by practicing regular medically supervised exercises.
2. Do not resort to restrictive diets. Try and eat small meals at regular intervals.
1. 3. While sleeping, ensure that there are an adequate number of pillows under your head and upper chest in order to keep the upper part of the gastrointestinal tract above the level of the rest which will help
    in significantly reducing the volume of reflux.
3. In case you have any symptoms, you can use a mild coating agent containing sucralfate which will also protect the oesophageal and stomach mucosa. Since this is a prescription drug, it would be best if you consult your primary care physician and ask about the same

3) Would long term PPI treatment typically be enough to prevent Esophagitis, and in addition, Barrett's Esophagus?

I would not recommend long term proton pump inhibitors (PPIs) in cases such as yours. They should not be taken over a prolonged period without a justifiable indication.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards
Dr. Vaibhav Banait

[beth0277]

*Also, my original Upper GI was a few months after giving birth, so I did have some additional weight on me. During the last year, I have gained additional weight due to the SSRI's that I took. I am about 25 pounds overweight and not sure if that could add to the problem.