You state that his problem has been present for over 25 years.
Continuous pain and heartburn
still indicates acid sensitivity.
I am assuming he is still currently on oral PPI, since injectable
gave him some relief. He should be taking the
medication twice a day, 20mg twice about an hour before his
big meals. I am sure he has been told to cut back on caffeine,
alcohol,tobacco products, tomato based foods, avoid too much
dairy to control the acidity. I am also assuming he has had an
endoscopic examination of his espphagus and stomach with biopsy.
He should have been tested and treated for H.pylori bacteri which
is responsible for duodenal ulcers and inflammation of the stomach
lining, chronic gastritis
. Intestinal TB typically affects the junction
between the small and large bowel and can present itself as a lump
in the right lower quadrant of the abdomen, low grade fever
sweats), fatigue and unexplained weight loss
, may or may not be
associated with diarrhea or bleeding.
If all the investigations including blood tests were normal , other
causes such as depression
has to be considered.
Hope they have done Celiac panel
blood tests to rule that out.
If your brother has had prior abdominal surgeries, chronic pain
could be from adhesions or scar tissue and trapping of nerves.
Sometimes, laporoscopy and exploring the inside of the abdominal
organs may be necessary.
Hope this gives you something to follow through.
Wish your brother well.