His heartburn was way out of control, even on maximum doses of pantoprazole and ranitidine. It burned all the way up behind his breastbone and he could feel the choking quality of the sticky acidity deep in his throat.

He hurt and coughed after eating, so hard that he would vomit and lose his breath. What he vomited was mostly mucous. “It’s like my esophagus is bubbling over,” he described it.

If he missed a dose of either medication, his symptoms worsened within an hour. “So the medications must be doing something, but nowhere near enough,” he told me.

A couple of years ago, he had been turned down for an upper endoscopy because he also happened to have severe angina, and the gastroenterologist was concerned about his anesthesia risk.