Brief Answer:
Reflux disorder with gastritis.

Detailed Answer:

Hello,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

As per your query most likely your symptoms are due to severe reflux disorder with Gastritis overlapped with mild dyspepsia.

Retrosternal chest pain(behind ribs) with history of belching and heartburn is classical tell tale symptom of patient of acid reflux. GERD is a condition in which stomach acid travels up the esophagus, which can then create ulcers and scars that constrict the esophagus. The mucosal lining of our stomach and mouth are not meant to tolerate acid reflux therefore recurrent reflux of acid destroys the mucosa and causes mild inflammation leading to heartburn and pain.As voice box etc are located adjacent to esophagus their membranes are also inflammed by acid regurgitation causing pain in swallowing and severe burning.
Frequent retrosternal heartburn is a cardinal symptom of reflux disorder,acid reflux causes a retrosternal or epigastric burning feeling that characteristically radiates up towards the throat, Sometimes this burning sensation can be pulsating also.Every time the acid from stomach refluxes back into esophagus it injures esophageal mucosa.This injured mucosa undergoes severe spasmodic contractions due to inflammation causing sensations of abdominal spasm.

Tests suggested are-
Manometry-This test allows to determine if muscle disorders exist in the esophagus, thus making it difficult to push food and liquids down into the stomach.
Endoscopy should be done to see the condition of mucosal layer and to see peptic ulcers.

Now lets move to your treatment-
See as the name suggests ACID REFLUX should be treated in two phases-
1)Control production of acid-For which you are on Panoprazole but 40 mg is too low dose.Shift to Rabeprazole and take it twicecdaily 20 mg before food.
2)To prevent the acid formed inside stomach to reflux back into esophagus-(This part of treatment is not covered by your doctor)-I would suggest you to add Levosulpiride. Itis a prokinetic drug and is very effective in controlling reflux of acid back into esophagus.A better way is to take it with Rabeprazole trials have shown that its very effective when combined with Rabeprazole.


3)Sucralfate is used to treat and prevent ulces and heal mucoda.Sucralfate works by forming a coating' over the ulcer. This protects the ulcer from the acid of the stomach, allowing it to heal. Sucralfate is best taken with water on an empty stomach 1 hour before meals and at bedtime.
General precautions are-
Follow a bland diet (low acid levels, low in fat, not spicy)
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco, and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of the bed before sleeping.
Avoid clearing of the throat.


Follow up in 10 days.

Warm regards!

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