Three years ago, I was diagnosed with mild esophagitis through an endoscopy procedure. My symptoms went away after eight months of Prilosec therapy. But about five months ago, I developed a problem: I need to stand and lean forward to my left in order to burp! I could live with that, but my indigestion also began to get worse and food was not going down well. My gastroenterologist put me back on Prilosec again. The extreme discomfort subsided, but I still have difficulty burping, and food seems to go down slowly. What is my problem? I imagine there being a crimp in my esophagus that makes my food pass slowly and blocks gas from escaping. Is this possible?

L.

Esophagitis, an inflammation of the lining of the esophagus, is a result of acid reflux from the stomach. The usual treatment for esophagitis caused by gastroesophageal reflux disease (GERD) is medication aimed at preventing acid production in the stomach. These medications include cimetidine (Tagamet) and ranitidine (Zantac), both of which are available over-the-counter. More potent acid-suppressive medications are the proton-pump inhibitors, lansoprazole (Prevacid) and omeprazole (Prilosec).

In the vast majority of patients, even those with severe esophagitis, the inflammation and symptoms will improve with this therapy. Since GERD is a chronic disease, patients often will have to take a daily dose of medications indefinitely even after healing to prevent a recurrence of esophagitis.

In your case, it sounds as if the medication was successful, since your symptoms went away with Prilosec therapy. However, your new complaint of food going down slowly and difficulty in burping is significant. One of the complications of esophagitis is the formation of scar tissue in the esophagus, known as a stricture. The stricture blocks the esophagus and makes it difficult for food to pass through. This basically is the "crimp" that you are describing, and it can progress so that eating any solid food can be problematic.

In your case, a stricture may have developed after you stopped taking the Prilosec (you did not mention whether you stopped the medication after the esophagitis resolved). Alternatively, the fact that your esophagitis got better after eight months may actually be because of the stricture. A stricture not only keeps food from going down, but it also can keep acid from coming up! Thus, some patients can see an improvement in their reflux because of stricture formation.

Regardless, the fact that you now have difficulty swallowing and burping means that you need to see your gastroenterologist and have another endoscopy to look for a possible stricture. If one is found, esophageal dilation can be done to stretch the area of esophageal muscle affected by the stricture. It is also important to continue taking the Prilosec, as you are doing.