Question: Hello,

Background: 24 y/o underweight male, referred to GI physician for constant, but varying in intensity, epigastric pain / discomfort x 8 months. Symptoms started at some point while on a 3-4 month high fat diet to gain weight (I was 33 pounds heavier after diet) where I would sometimes consume up to 1500 calories right before bed. The abdominal pain did not go away after stopping this diet. Diagnosed with IBS after upper endoscopy showed reason for my pain, but incidentally saw esophageal changes consistent with Barrett’s Esophagus.

Endoscopy report: Esophagus: Minimally irregular Z line at about 45 cm. Stomach: Minimal antral erythema. Retroflexion normal.

Pathology biopsy report of distal esophagus; Minute focus of Barrett’s Esophagus, negative for dysplasia. Benign squamocolumnar junction with minor chronic inflammation. No evidence for eosinophilic esophagitis or fungal hyphae.

Abdominal ultrasound: Negative.

Current state and plan: My GI physician told me I have a small <1 cm focus of Barrett’s (ultra-short segment) that is not circumferential. Plan is 20mg omeprazole every morning and return for follow-up upper endoscopy in 1 year.

Current symptoms: epigastric pain / discomfort and frequent belching. Normal bowel movements since initial diagnosis of IBS.

Questions:
1) Are my symptoms more consistent with dyspepsia and if so does this change any treatment plan?
2) Is there any chance my epigastric pain is related to reflux?
3) My doctor said that for my Barrett’s I can eat and drink anything that doesn’t give me symptoms. My epigastric pain gets worse with certain foods, but I do not have classic reflux (i.e. heartburn) symptoms. I have stuck to a very safe reflux diet (low fat, low acid, low caffeine, etc.) because of fear. However, I am losing weight (17.1 BMI). I have developed anxiety and stress from looking for symptoms after everything I eat. Can I really eat anything or will it increase my risk of progression to esophageal adenocarcinoma?
4) Should I return to my doctor and ask for a referral for a 24-hour pH testing and / or Barium swallow test? Will this give any valuable information? I think maybe it will put my mind at ease if I have a normal lower esophageal sphincter with normal amount of reflux, and if not at least I know that I’m doing the right thing by following my very strict diet and lifestyle changes.
5) What does the “minimal antral erythema” on my stomach endoscopy report signify?
6) What does “minor chronic inflammation” of my squamocolumnar junction endoscopy report signify?

Hello Dr. K,

Thank you for the reply. I do have a few follow-up questions that I would appreciate if you could answer.

1) Will I have this epigastric pain for life if it has not gone away in 1 year?

2) Do you believe my epigastric pain is due to gastritis even if it did not change after starting 20mg omeprazole daily? Can any medication take it away?

3) Do my pathology and endoscopy reports indicate without a doubt that I have GERD even though I don't have any of the classic symptoms?

4) If I may eat anything that doesn't cause me symptoms, does this include frequent belching and epigastric pain? I always have these two symptoms, but some foods may make it worse. However, the same foods do not always cause my body to react the same way.

Hello Dr. K,

I forgot to mention that antacids (standard calcium bicarbonate) does not alleviate any epigastric pain. I don't know if this might help in determining the cause of the pain.

Hello Dr.R.K,

Thank you for your reply. I understand all your answers.

I have three more unrelated questions:

1) When I eat a new "trigger" food / drink, I start feeling epigastric pain in just a few seconds. Would this be considered too soon to be pain from reflux? I should also note that sometimes I wake up with mild epigastric pain though usually it builds up through the day from just a slight discomfort.

2) Since initially seeking medical evaluation for my epigastric pain, my pain has worsened. Before, it was more a slight discomfort that was easily ignored. Now, after eating, sometimes my pain is so bad that I cannot think about anything other than the pain. I think worrying only makes the pain worse. Can you please suggest alternatives to pills that I could implement to lessen my anxiety and worrying naturally?

3) Going off of the question above, I understand that exercising can make one feel better and worry less. However, I have stayed away from it because I cannot afford to expend any calories due to being so underweight and because I was told exercise is bad for reflux if done after meals (and I'm told to eat frequent, small meals). When is the best time in the day to exercise if I were to do so? How long after a meal is safe?