instruction: a couple of weeks before I got severe heartburn I often felt really bloated and nauseous especially after meals but I kept ignoring it as the symptoms would go away a month back I had a faint heartburn throughout the day and woke up in the middle of the night with severe heartburn all over my chest mid week it was so bad that it went in my throat and everything I went to the hospital and was immediately prescribed ranitidine 150mg for 14days as it came to week I got only worse with no sleep whatsoever lump in my throat extreme fatigue where my leg was involuntarily fluttering and my lip was voluntarily twitching by third week I started omeprazole 40mg with the ranitidine and the heartburn intensity reduced but I experienced lots of other symptoms like bloatedness stomach making noises all the time nausea breathlessness was the main one heart palpitations which were never ending and this constant pressure on my nose and head I am now in week and unfortunately the heartburn is still very much there it comes and goes the lump in my throat has improved from the second week but it still feels very heavy I can almost press it and feel something clicking doc has said to double my dose of omeprazole so to take 80mg plus ranitidine will I get any relief at all from this constant heartburn and all the other symptoms am I in some sort of serious trouble I have lost quite a bit of weight I am on bland food elevated at night and all the lot but yet my quality of life is so heavily impacted as I cannot do anything throughout the day because of the constant palpitations heartburn or pressure in my nose and head or the bloatedness and nausea the heartburn gets worse after I eat please help I am only 28 and do not understand why this happened to me as I was never obese or had any health conditions except hypothyearoidism last thing to mention my stools since having acid reflux issue has been a pale yellow and has only recently started to be brown again what could this mean as well any help would be appreciated as docs are just putting it down to anxiety and stress all the time
output: hello I welcome you to icliniq I can understand that must very much frustrated for your ongoing non resolving symptoms I want you to understand why this symptoms of heartburn occurs in reality hear burn is a common symptoms that can occur in normal subjects as well but does remain long in some people heart burn occur secondary to acid reflux in food pipe esophagus which usually settles with one dose acid suppressant medication or twice daily capsule however there is a third group of individuals where by the maximum does acid suppressant does not effect very much as in your case we call this condition as refractory gastroesophageal reflux disease herd so why I started emphasizing on all this because management is different the work up of refractory herd start with an endoscopy a procedure where by a gastroenterologist puts a tube with camera in to your esophagus and see what is inside also there are other battery of test which could confirm what is exactly a problem may be straightforward I reflux but it can be some thing which is micking herd the herd mickers are many the one of most common are esophageal motility disorders which are another set of disorders in itself so to cut the story short I want you to first of all optimize the acid suppressant treatment I know you taking omeprazole 40 my twice daily but it is important you take these medication 30 minutes or sometime 45 min before meal it is very important since at times it is timing which is important than the drug itself but if you are doing it already in that manner I would recommend you to think about endoscopy now but it would help us to determine some other more information not necessarily the acid reflux keep taking gaviscon but increase the dose take 15 to 20 my at one time to times daily and half hour after meals the rest of your symptoms such as feeling lump in throat is common if someone has reflux it is called as globes sensation dont worry about that it will go away once your acid controlled adequately the stress and anxiety sometime create a vicious cycles where the disorder is perpetuated and influenced by it but I think this is not the only explanation of your problem the stress is obvious thing in one with non resolving symptoms for example if do not reach to a particular diagnosis by endoscopy I would consider testing for esophageal motility disorders and some more allergic and hyperalgesic problems of esophagus but for now let the above treatment plan work meanwhile get some blood test done as advised below I hope this would be helpful for you let me know if you need any future consultations have a good day refractory herd complete blood count check your thyearoid status ash ft4 ft3 herd motility disorders esinophilic esophagitis after week