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Contact your healthcare provider if you experience: Severe or persistent heartburn that does not respond to over-the-counter medications or an 8-week trial of optimized PPI therapy Difficulty swallowing (dysphagia) or painful swallowing (odynophagia) Unintended weight loss beyond expected therapeutic effects Persistent nausea or vomiting that interferes with adequate nutrition or hydration Severe, persistent abdominal pain (especially if radiating to the back, which could indicate pancreatitis) Right upper quadrant pain, fever, or yellowing of skin/eyes (possible gallbladder disease) Seek emergency care immediately for: Chest pain (which could be cardiac in origin) Vomiting blood (hematemesis) or material that resembles coffee grounds Black, tarry stools (melena) suggesting gastrointestinal bleeding Symptoms of dehydration including decreased urination, dizziness, or confusion These symptoms may indicate complications such as esophagitis, gastric ulceration, or other serious gastrointestinal pathology that requires investigation