instruction: hello doctor heartburn and indigestion all day frequent belching gurgling in throat esophagus throat or esophagus is making a funny noise off and on for years sporadically diagnosed with herd and larapharyngeal reflex clean endoscopy in years back but esophagus is slightly twisted had dilation during procedure other endoscopies were fine is this classic signs of herd saw ent recently for other issues throat looked good just never had the gurgling as much taking gas and protonic and tums here and there also deal with allergies and post nasal drip no vomiting or fever just uncomfortable
output: hello most of the symptoms such as burping gurgling within esophagus and funny noise all can be encompassed in to one diagnosis that is herd but thing which make concerned are you have endoscopies and all showing normal without signs of ulceration which is not usually a case in herd patient unless they are on maximal acid suppressant medications and symptom free at the time of undergoing endoscopy so endoscopy result has to be correlated with the timings and weather use of acid suppressant medication before making a diagnosis given some more interesting findings like dilated esophagus and no ulceration at the time of endoscopy with presence of persistent symptoms suggest some other additional problem bystanding with herd such as motility disorder some time herd is just a manifestation of motility disorders because two disorders almost cause similar symptoms secondly for herd one must have oh imepdence monitoring to confirm the diagnosis and in case you have already gone through this then you come in category of refractory herd not responding to usual acid suppressant medications for refractory herd the only single test that can confirm symptoms correlation index acid reflux causing the symptoms or non acid reflux causing symptoms or no acid reflux at all is oh impedence test while person on acid suppressant medications I can understand it must be very exhaustive and confusing for you to understand above things but it can be very easy while investigation all these possibilities I urge you to upload your previous reports and keep in touch with me as I can suggest you how it is further be approached refractory herd oh impedence monitoring motility disorder functional heartburn refractory herd suggest investigation you can follow up with me to discuss about how to approach this