I've been taking pantoprazole (Proton Pump Inhibitor (PPI)) 40mg for over 2 weeks for gastritis, after being treated for H. pylori infection, but I'm still experiencing a weird sensation when swallowing, chest pain radiating from front to back, tenderness in the arm pits, stiff neck, and electrical sensations, should I continue with the current treatment or seek further evaluation from a gastroenterologist?

Management of Persistent Symptoms After H. pylori Treatment and During PPI Therapy

Based on your symptoms and treatment history, you should seek further evaluation from a gastroenterologist as your persistent chest pain, swallowing difficulties, and other symptoms despite 2+ weeks of PPI therapy warrant additional investigation to rule out other causes beyond GERD.

Current Situation Assessment

• You've been treated for H. pylori infection (confirmed eradicated with negative tests) and are currently taking pantoprazole 40mg for presumed gastritis 1
• Despite 2+ weeks of PPI therapy, you're experiencing:
  • Unusual sensation when swallowing (especially on left side of neck)
  • Chest pain radiating from front to back
  • Pain triggered by certain foods (chocolate) and sometimes by taking PPI on empty stomach
  • Tenderness in armpits
  • Stiff neck and "electrical" sensations 1

Why Further Evaluation is Needed

• According to AGA guidelines, inadequate response to PPI therapy after 4-8 weeks OR presence of alarm symptoms warrants further investigation 1
• Your symptoms include several concerning features:
  • Persistent chest pain despite PPI therapy
  • Swallowing difficulties
  • Radiation of pain to back
  • Neurological-type symptoms (electrical sensations) 1
• These symptoms could represent:
  • Inadequately treated GERD requiring dosage adjustment
  • Non-GERD esophageal disorder
  • Functional esophageal disorder requiring different approach
  • Other non-GI condition 1

Next Steps Recommended

1. Consult with a gastroenterologist for proper evaluation of persistent symptoms despite PPI therapy 1

2. Consider endoscopic evaluation to:

   • Rule out erosive esophagitis
   • Assess for other esophageal disorders
   • Evaluate for complications of GERD 1

3. Potential PPI optimization while awaiting specialist evaluation:

   • Ensure proper timing of pantoprazole (take 30 minutes before morning meal) 2
   • Consider twice-daily dosing if symptoms are severe 1
   • Don't take on empty stomach without food following 2

4. Adjunctive therapies to consider discussing with your doctor:

   • Alginate antacids for breakthrough symptoms
   • H2-receptor antagonists for nighttime symptoms
   • Avoid known triggers (like chocolate in your case) 1

Important Considerations

• PPI safety: PPIs are generally safe for short and long-term use; focus should be on finding the right diagnosis rather than concerns about PPI use 1

• Potential for non-GERD causes: Your symptoms pattern (electrical sensations, stiff neck, armpit tenderness) suggests possible non-GERD components that require proper evaluation 1

• Timing matters: If symptoms are worse in the morning, this could indicate nighttime reflux requiring additional management approaches 1

• Post-H. pylori considerations: After successful H. pylori eradication, some patients still require acid suppression for symptom control, but persistent unusual symptoms should not be attributed solely to post-treatment gastritis 1

• Warning signs: The combination of swallowing difficulties, chest pain radiating to back, and neurological-type symptoms requires proper medical evaluation rather than continued self-management 1

Remember that finding the right diagnosis is crucial for effective treatment. While pantoprazole is effective for acid-related disorders 3, 4, your symptom pattern suggests a need for comprehensive evaluation to ensure appropriate management.