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Severe heartburn - No improvement despite PPIs

Hello,
I have been experiencing severe heartburn problems for quite some time now: Initially, I only had a sore throat, which lasted more or less continuously from October to December 2012. In December, I noticed severe heartburn, which I initially tried to alleviate with Maaloxan. Furthermore, since that time I have been suffering from constipation, even though my diet is balanced and I eat at least two portions of fruit every day. Digestive problems have now largely subsided. However, I still have heartburn. At times, it is so severe that I already experience intense heartburn when drinking a glass of water after getting up in the morning. Sometimes, the heartburn cannot even be calmed down with several doses of Maaloxan Suspension. There are days when I have no problems at all, but there are also times when I experience very severe heartburn.
I went to a gastroenterologist for this reason, who performed an endoscopy. The findings are as follows:
Intact mucosa throughout the esophagus, healed erosive reflux lesion at 40cm from the dental arch. Z-line otherwise inconspicuous. Small axial hiatal hernia (passage through the hiatus at 42cm from the dental arch). Inconspicuous mucosa in all gastric sections as well as in the duodenum up to Pars II duodeni.
As a result, I was prescribed PPIs, which have hardly helped. According to the gastroenterologist, I should not worry, as things would calm down on their own. However, it has been almost two months since the examination and there has been no improvement. Subsequently, I went to see this doctor a second time, who gave me the same advice to continue taking PPIs.
However, I am not satisfied with this situation, as I still experience heartburn throughout the day despite taking Maaloxan.
About me: male, 26 years old, 183cm tall, 72kg, jogging 2-3 times a week for 8km each time, office job, otherwise no complaints.
I hope you can help me!

Dr. med. Frauke Gehring

Good evening,

Unfortunately, you did not mention the PPI and the dose that Sue has been taking. Omeprazole is twice as strong as Pantoprazole, so the dose should be 40 mg, taken on an empty stomach in the morning. If taken on a half-empty stomach, they will be ineffective. Additionally, you can also take Maaloxan if needed.
The heartburn is caused by the hernia and the resulting loose closure of the stomach entrance. Therefore, please elevate the head of your bed by about 7 cm so that the acid cannot flow back. Also, avoid eating foods that are too fatty, hot, large, or spicy.
A hernia can also be operated on, but it is a major and not risk-free procedure. Therefore, it should only be considered as a last resort.
I wish you a speedy recovery!

Warm regards,
Dr. Höllering, Specialist in Internal and General Medicine

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Experte für Internal medicine

Dr. med. Frauke Gehring

Dr. med. Frauke Gehring

Arnsberg

Staatsexamen 1984 in Kiel, seit 1992 in eigener Praxis niedergelassen. Onlineberatung seit 2001 bei Almeda, Focus (als ärztliche Leiterin), Onmeda, Bild der Frau. Moderatorin, Dozentin für medizinische Themen.

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