A Twenty-one–Year–Old College Student With Postprandial Regurgitation and Weight Loss

A 21-year-old college student is referred for evaluation of “reflux” symptoms refractory to high-dose proton pump inhibitor medication twice daily for the past 9 months. Her symptoms occur daily after nearly all meals. She describes repeated regurgitation of food into the back of her throat beginning no longer than 20 minutes after she starts eating. When she is eating alone, she will rush to the restroom to spit the food out. When she is eating with others, she eats more slowly and has trained herself to swallow the regurgitated food back down. When she repeatedly swallows the regurgitated food, the latter becomes bitter and sour within approximately 20 minutes, and she has to spit it out rather than re-swallow it. For this reason, she will rarely eat an entire meal when she is in the company of others.