Thanks for the additional information,
Sorry it was sweating, not swearing was a typo :), well glad to know there isnt any swearing :).
Anyway coming to the point, well i believe your physician has you on the initial period of GERD treatment in which treatment is tried without any tests BUT that last for 4 - 8 weeks, if the patient doesnt show any signs of improvement then we move onto the next step which is getting the tests that i described done, so here the next step for you should be,
24 hr ph monitoring test to see if there is an acidic ph in your oesophagus
Barium swallow if needed.
i believe the squeezing sort of pain that youre experiencing is probably due to one of two causes. One is that of oesophageal spasms which can accompany GERD and this can be picked up on ph monitoring and manometry studies which checks the pressure in the oesophagus. This is a common condition which can occur with or even without GERD, this condition is usually initially treated with the same treatment as GERd but if that doesnt work then the next step is to do the tests and then add calcium channel blockers or nitrates to the medication regimen.
Now the other possibilty whcih i must mention here is that of heart conditions, the reason i mention this inspite of your young age is because you mentioned an arrythmia, which may be unspecified, in one of you EKG leads. By itself it is insignificant but in the presence of symptoms like yours and also the fact they are not improving with conventional GERD therapy, this means that the heart MUST be ruled out. the minimum testing which should be done consists of the following,
24 hour holter monitoring which is essentially a 24 hour EKG via a device which you can wear at home.
These are tests which should be done in light of the failure of the GERD therapy.
Now another reason for the failure of your GERD therapy can be H.pylori infection which can worsen the symptoms and thus cause oesophageal spasms, this can be checked with the help of Urea breath testing and stool antigen test for h.pylori. This if positive can be treated with antibiotics.
Lastly, im surprised that conservative measures were not advised by your doctor, ill give you some of them to try and ill give you a useful link to read and then implement those strategies,
Raise the head of the bed at night with the help of 3-4 pillows
Eat your last meal 2-3 hours before bedtime
Eliminate smoking and alcohol from your diet
Cut down on your weight if overweight
Here is the link i mentioned,
I would suggest that you discuss these with your doctor and also if prevacid isnt helping ask him to change you to a higher dose or to some other drug like esomeprazole or rabeprazole. Sometimes different drugs can help as well. I hope this helps you