Brief Answer:
Treat the root cause i.e hyperexcited autonomous nervous system..

Detailed Answer:
Hi,
Thanks for choosing HealthcareMagic for your query.
I have gone through your details and i appreciate your concern.

For explaining her treatment i have to initially give you a briefing about the cause of her problem.Our nervous sytem has got a Autonomous part termed medically as autonomous nervous system.This part of the nervous system is responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.
Acid is secreted in stomach by parietal cells and motion of the wall of stomach and intestines is controlled by autonomous nervous system.By autonomous its obvious that a person brain can't directly control it.When levels of anxiety increases autonomous nerves innervating gut get stimualted(Vagus nerve) leading to increased secretion of acid by parietal cells in stomach and increasing reflux of acid back in esophagus causing severe burning sensation and fullness.

The treatment she is on covers only one part of pathology i.e acid production(Pantoprazole is a proton pump inhibitor and stop parietal cells to secrete acid).
(Domperidone is aprokinetic drug and stop reflux of acid back into esophagus).

But even you can see that the main pathology or root cause is not covered by any of the medicines she is on.In lay mans language-"Take care of her anxiety and all symptoms wil settle down by themself as anxiety is the root cause of all her symptoms".
Unfortunately she is not on any anti nxiety medication(which soothens her autonomous nervous system).
Suggestions-
Acotiamide is a new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide,a gastrointestinal motility modulator,at a standard dose of 100 mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.Ask your gastroenterologist to add it and should be taken for 3 months minimum.

Replace domeridoe by levosulpiride(better results).

Increase dose of pantopraziole to twice daily 40 mg can be increased to 80mg twice daily.
Very important-
Add a benzodiazepene to her regimen.They are anxiolytics and are very effective in calming down autonomous nervous system.Ask doctor to start her on 1mg lorazepam initially.This medicine would calm her autonomous nerves and hence would help her to cope with her symptoms.As anxiety levels settle down secondary symptoms wil also subside.

SSRIs ease anxiety by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. They should be added with benzodiazepenes.Initially start her on Paroxetine 12.5 mg once daily.doses will be increased to 25mg once daily as per the response of her body.

Discuss all with your Gastroenterologist.Question him/her that if she is diagnosed as having emotion(anxiety or autonomous system ) related gastritis then why a mood stabiliser anti anxiety medication was not started.
Follow what i suggested and tell me how she is feeling after 21 days.


I am not writing down about life style changes because i feel you must be knowing them very well.However in case you want me to provide you with advice on that,Feel free to revert back.
Hope i was helpful.
Thanks.

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