###Human: Will I get any relief at all from this constant heartburn and all the other symptoms? ###Assistant: 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 (GERD). So why I started emphasizing on all this, because management is different. The work up of refractory GERD 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..e. reflux, but it can be some thing which is mimicking GERD. The GERD mimickers 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 mg 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 ml at one time, 4 to 5 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 globus 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 GERD complete blood count Check your thyroid status. TSH, FT4, FT3 GERD Motility disorders Esinophilic esophagitis After 1 week