We have reviewed the entire history of 15 years and the investigations
and treatment done till date as posted in your health record here at
this
link:
http://care.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=223
Your 24 hour esophageal pH monitoring done once in 2009, Gangaram showed
significant esophageal reflux that can explain your symptoms. However
if the symptoms were solely due to acid reflux they should have
disappeared by now but as per your report they haven't.
The next most important consideration in the cause of your pain is
visceral or esophageal hypersensitivity. The best test for detecting
this condition is a balloon distention test. (See page 51
here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038318/pdf/GH-07-50.pdf)
I would suggest that you repeat the 24 hour pH monitoring test from the
nearest center of your choice and if normal now (due to the Nissen's
fundoplication done in 2010) you should be investigated for visceral or
esophageal hypersensitivity with a balloon distention test.
Visceral hypersensitivity is a heightened conscious perception of
visceral stimuli independent of the intensity. Heartburn is perceived
and modified by the central nervous system, a complicated process that
is being elucidated using esophageal evoked potentials by
electroencephalogram, positron emission tomography, functional magnetic
resonance imaging, and other methodologies.
Dr
Satish S. C. Rao,
Professor of Medicine, University of Iowa seems to have done the
maximum amount of work in this area and in this paper
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038318/ he feels that If an esophageal pain is ascertained as due to visceral hypersensitivity then a trial of Tablet Theophylline may help.
Do keep us updated on your progress an wish you a speedy recovery.