Can I Take Clonazepam For Anxiety Any Concerns About The Influence Of The Medication On Reflux?

Question : I recently had an upper endoscopy for recurrent issues with swallowing. For about ten years, I’ve had occasional difficulty swallowing certain foods. It feels like the food slows or stops in the esophagus. I’ve had endoscopies nearly annually since 2012.

I’ve been on pantoprazole 40mg in the morning for about 10 years, and an H2 blocker at night for same.

Occasionally, my prior gastroenterologist would perform esophageal dilatation. The PPIs helped for a bit, but in recent years have worked to control reflux discomfort, but not the difficulty swallowing.

My current gastroenterologist (my former one retired) is approaching treatment slightly differently. She believes that eosinophilic esophagitis rather than GERD is causing the swallowing issue. She doesn’t seem as concerned with the acid reducing medications, and has suggested I look into Dupixent. I had seen an allergist and have no known allergies following scratch test. I have also tried swallowed fluticasone inhaler with little improvement.

The severity of the difficulty swallowing varies. Sometimes there is no issue. Other times, with bready or meaty foods, it is quite severe and requires me to “force” it down by drinking liquid.

Other notes:

I was at one time diagnosed with a hiatal hernia on a barium swallow fluoroscopy, but it was never noted on the endoscopies.

My former gastroenterologist has diagnosed Barrett’s visually, but the biopsies were negative. I’ve seen that my current gastroenterologist notes irregular z-line. I assume this is why he visually suspected Barrett’s.

I am attaching the procedure notes and pathology report.

My questions:

1) What are your thoughts on the eosinophilic esophagitis diagnosis and treatment plan? Dupixent is an intimidating step because it is so new, and I don’t relish the idea of being placed on an immunosuppressant. Are there any alternatives? I have no known allergies—could the eosinophilia be caused by reflux? Is there any significance to the location of the eosinophils in the esophagus (GE junction vs lower vs mid)?

2) Without intestinal metaplasia, is Barrett’s ruled out?

3) Any other avenues I can explore to help with the swallowing issue?

4) I take clonazepam for anxiety. Any concerns about the influence of the medication on reflux?