Question: I am a 51-year-old female who has had symptoms of belching, pain in my mid/upper back between my shoulder blades, and gas for years. Tests (upper and lower GI) revealed nothing. My doctor insisted about four years ago that it must be reflux and put me on Nexium and then Aciphex. Belching and pain symptoms improved but were never absent and now I now have a B12 deficiency (I'm a vegetarian). I quit taking the Aciphex and the pain in my upper back returned. It is temporarily alleviated by eating.

Dr. Hibberd's Answer:

You are long overdue for a more complete evaluation. The presence of pain is concerning. I am always concerned when treatment given provides only incomplete relief. I assume you have been properly evaluated for cardiac disease and aortic aneurism. If not, do it NOW. Once this is clear, see your gastroenterologist on referral for a scope evaluation (an esophagogastroscopy or EGD) and evaluation for your B12 deficiency. If unrevealing, you will need esophageal motility evaluation so that your treatment can be more focused (and more successful!) Hopefully you have no underlying disorder more serious than gastroesophageal reflux.

If I were you, I would also want to know why I was B12 deficient. This will be addressed by a two- step Shilling test. This is not because you are vegetarian!! Remember, listen to your body, and act on new symptoms. If the treatment offered seems incomplete and if you do not improve, get another opinion . . . EARLY!