Your symptoms are typical for acid reflux and the Dexilant is excellent anti-reflux medication. It is not unusual for the pain to radiate to the shoulders and or back. The chronic gastritis and inflammation can be cured by reducing the acid in the stomach. If your H. pylori was negative most likely hyperacidity it is causing the gastritis and inflammation of the junctional mucosa. I will make some suggestions for you for treatment of GERD but and first I will try to answer Your questions. Focal intestinal metaplasia usually is caused and occurs in conjunction with chronic gastritis. The best way of preventing progression of your intestinal metaplasia to dysplasia would be to rid the stomach of acid in order to prevent gastritis and thus prevent metaplasia. The causes of reflux inflammation has several different factors including relaxed esophageal sphincter which leads to the reflux. With the appropriate medication and diet you may have one or the other(gastritis) cured or both cured. On rare occasions if the acid reflux is severe even medication will not cure it and then surgery would be necessary. It is unusual in this day and age with strong acid suppressing agents. Hopefully this has addressed your concerns. following is the most up today information on GERD. Eat bland foods. Although many doctors tell their patients to avoid spicey foods, fatty foods, citrus fruits, tomato juice or sauce, chocolates, alcohol and carbonated drinks, coffee (also decaf), there is no scientific evidence that is is helpful. You should avoid PROVOCATIVE foods which are any foods that specifically causes you discomfort. You should also stop smoking. You should not eat anything 2 hours before bedtime. The head of the bed should be raised 6-8 inches (can use large cans with sand) and try sleeping with left side down IF you have nighttime reflux. Don't lie down for 2-3 hours after a meal. Some medications may make the reflux worse, including anti-cholinergics, NSAIDS, antibiotics, anti-depressants, nitrates, progesterone, beta blockers
and calcium channel blockers, iron, potassium, sedatives and bronchodilators. Several non-prescription agents may help; Gaviscon, Mylanta or Maalox as directed on bottle, acid suppressing agents such as OTC Tagamet, Zantac, Pepcid, or Axid or the stronger agents ( PPI's) such as Prilosec or Nexium, Prevacid, Aciphex and Protonix. Again follow instruction on the labels. Your Doctor may want to double your dose if you fail to improve.
It is important to LOSE WEIGHT if you or overweight. This has been clearly associated with worsening of reflux disease.
If you do not improve on the above regimen or if you have trouble swallowing or pain upon swallowing your doctor may want to proceed with other tests such as endoscopy or pH monitoring.
If your symptoms persist or worsen, surgery ( laparoscopic Nissen Fundoplication
) may be considered.
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