Dr. Bahram Forouzandeh

Unfortunately, the natural course of acid reflux disease is unpredictable and even surgery such as fundoplication and newer endoscopic techniques to relieve acid reflux lasts 5-10 years, and more than 50 percent of people undergoing surgery will be back on acid-reducing medications after 5 years.
There’s times when acid reflux can be cured if it's related to sudden weight gain, smoking, or drinking too many caffeinated beverages after correcting these factors. Most acid-reducing medications are safe in the long term and most side effects have been rejected in more detailed studies. It is advisable to avoid any medication including acid-reducing meds if potential side effects outweigh the benefit of relieving occasional reflux episodes that can be managed with an on-demand approach to take it when you have symptoms if it is not persistent and does not return as soon as you stop the medication. Ignoring symptoms of severe and persistent acid reflux disease to avoid potential unproven side effects is not wise. It will affect your quality of life and increase the chances of complications such as narrowing of the esophageal lumen due to scar tissue formation, ulcer, bleeding, and possible developement of esophageal cancer.

The change in bowel habit can be triggered by taking medication such as pain killer, muscle relaxant, antidepressants and many others that need to be taken into consideration. Akse emotional stress is another important factor which can contribute to constipation. If all the above factors are not present in your situation, you need to be seen by your primary care doctor and to be referred for colon investigation, such as blood in the stool, X-ray, and colonoscopy to make sure you do not have any obstructive lesion given the fact we see increased incidence of colorectal cancer at a young age.
The presence of constipation increases fermentation of colonic content by bacteria, which contributed to gas formation and bloatness and will improve by treatment for constipation.

People with gastroesophageal reflux disease, or GERD, can present with classic symptoms such as burning sensation behind their sternum associated with occasional regurgitation and nausea.
In elderly people, the presentation of GERD may be more subtle and they may present with complications of GERD such as luminal narrowing due to scar tissue formation with trouble swallowing or precancerous lesions called Barrette’s esophagus, which is the development of intestinal tissue replacing normal lining layer of esophagus.
In younger people, particularly young children, nausea and vomiting as well as poor appetite are more common symptoms compared to adults who present with classic symptoms of GERD.
Other less frequent symptoms are trouble swallowing and atypical chest pain as well as hoarseness with sore throat with occasional dental caries.
To diagnose GERD, we can try to treat the patient with typical symptoms.
Other diagnostic tests include endoscopy looking for pathological damage on biopsy or more specific and specialized tests such as pH monitoring.
In pH monitoring, we measure 48 hr acid exposure in the lower esophagus by placement a small device in the esophagus while the patient charts his or her symptoms carrying a belt which receives signals from the device.
These tests are more appropriate for the people who do not respond to acid reducing therapy for 4 weeks or have atypical symptoms.
Also, any patient with alarm symptoms with GERD such as bleeding, low blood count, trouble swallowing and weight loss, endoscopy should be done initially before empirical therapy with acid reducing medication.
During Endoscopy, only 50 percent of people have evidence of tissue damage to esophagus and the remaining 50 percent have normal esophagus who need more specialized tests as was mentioned to diagnose GERD.
It is noteworthy to remember there is a large number of individuals who have depression or other underlying emotional disorders who do not respond to therapy and all their tests will be normal who might benefit from anti-depressive medications.
We also should keep in mind people with motility disorder such as Achalasia, which is inadequate relaxation of the sphincter between the esophagus and stomach, causing trouble swallowing, and food allergy called eosinophilic esophagitis can manifest with reflux symptoms, but the underlying mechanisms are different from GERD.
Interstingly, half of people with eosinophilia esophagitis also respond to strong medication used for acid reduction in esophagus before considering food elimination or using inhalar steroid.

There are many reasons for trouble swallowing from acid reflux disease complicated by narrowing of esophagus to esophageal motility problem as well as neoplasm of esophagus if associated with weight loss can be considered. Different caustic medications such as Doxycycline and infectious process such as candida and herpes can cause ulcer and painful swallowing more as acute presentation.

The most common cause of intermittent swallowing difficulty is food allergy which is called Eosinophilic Esophagitis diagnosed by endoscopy and biopsy being treated by avoiding six most known culprits such as milk, wheat, nuts. The therapy with inhaler steroids in resistant cases followed by gentle dilatation of esophagus in the case of luminal narrowing is recommended.