question: Hello doctor, I am a 33 year old male. I have had chronic constipation since my childhood. The doctors said that my gastric motility is a bit under-par. To rule out any physical damage, I went through colonoscopy three years ago. The reports only mentioned small hemorrhoids. I was on a brief course of antacids and laxatives after that, which gave me temporary relief. Constipation had reduced considerably by the end of last year. However, I have been experiencing acid reflux since early this year. This is the first time that I have had regular episodes of reflux. So, I did my endoscopy four months back. It revealed ulcers in the esophagus near the sphincter (GERD). It also revealed a small sliding hiatus hernia. No metaplasia seen in biopsy. The doctors said that since I am a young patient, surgery is not recommended. They said I have to rely on lifestyle modifications and antacids. Currently, I am taking Nexpro RD 20 mg capsules and Riflux Forte syrup. I have cut down on spicy food, and also have altered my meal times since the past one and a half months. The acid reflux has reduced by 60 to 70 % since the lifestyle change. However, I still experience some really disturbing symptoms: stinging chest pain at both the breast bones (especially after meals), occasional back-ache, frequent shortness of breath after meals, huge bouts of burping (with the feeling that air is trapped around the diaphragm), and overall fatigue. Regarding chest pain, I have undergone ECG, 2D echo, stress test, and troponin. All tests normal. The cardiologist has ruled out any cardiac problem. However, he has prescribed 2.5 mg of Nebicard SM to control my palpitations. He has already tapered the dose from 5 mg to 2.5 mg, I believe he will take me off the medicine soon. I need help to know what can I do to improve my symptoms.