Upper endoscopy. les healthy all normal. constant acid reflux though, why? no meds help or diet change. anything causes it. even empty stomach.

Must rule out ZES: Zollinger-Ellison Syndrome causes high levels of gastric acid and bad reflux.Blood test ( Gastrin level ) is helpful. You may just have treatment resistant reflux. Possible causes are many. Strict regimen: remain upright for 3 hours after every meal,Nexium 1st thing in AM and eat 30 min later. Increase to twice daily Nexium guided by symptoms,endoscopy surveillance ,elevate head of bed 30 degrees.

Other substances : There are several things that make reflux worse. Nicotine, caffeine, and alcohol. If you are not a big user of one of these, please see your primary care provider. There is something called Zollinger-Ellison that causes increased acid production, even despite meds.