Q: I am 39 years old. I have a family history of acidic problems. Recently my uncle has expired due to cancer (related to the digestive system). This has made me uneasy. I have severe acidity and refluxes since late 20s. I had two endoscopic tests and one gastroscopy in the last 3 years. The first two were normal but third endoscopy shows a minor esophagul ulcer. I am on Nexium (20mg) pills, for last one year, as advised by my specialist. But there is no any improvement. Though the refluxes have been reduced, I can sense other symptoms like headache, nausea and tiredness everyday. If I change my food style slightly, it affects me a lot. I prefer mild Indian style food, not too hot and spicy. My doctors are sure that there is nothing serious and there is no reason to panic. Should I go for one more endoscopy and biopsy? How long should I be on Nexium tablets? If nothing is wrong, then why cant I have a normal routine of eating and drinking? Do I need to undergo surgery?

A:The information you have provided makes a diagnosis of Endoscopy Positive Gastroesophageal Reflux Disease quite reasonable, and your specialist is quite correct in prescribing you Nexium 20mg a day. If your symptoms of heartburn and acid reflux are not better with this dose then depending on whether you have daytime or night time symptoms, a 40mg in the morning or 20 mg twice a day would be the next step. A repeat endoscopy and biopsy are not needed, and would not change the line of management. From the information you have given me, it does not appear that you have been given a diagnosis of Barretts Oesophagus, and this would be the only reason for your to have repeated endoscopies/biopsies. Nexium can be taken safely for a long time and is also now licenced for On Demand medication. Your doctor should be able to advise you on when to change to on demand medication. Surgery, as has been rightly told to you, is only reserved for difficult and refractory cases of reflux disease, and often is not very successful. The fear of a digestive tract cancer cannot be sunstantiated at the present moment and there is no indication that you need any further checks for this, unless I have more information about the location of the digestive tract cancer in your uncle. Even so, he is not a first degree relative, and the current understanding of risk is that it is quite low for those whose second degree relatives have the cancer.