Role of Pain Modulation in GERD Patients Who Failed Standard Dose Proton Pump Inhibitors (PPI)

Inclusion Criteria: * Male or female * Ages 18 to 75 * At least two episodes of heartburn per week while on PPI once daily * Able to communicate with the investigator and comply with the requirements of the study * Subjects who give written informed consent after being given a full description of the study. Exclusion Criteria: * Known allergy or intolerance to TCA * Use of antidepressant or a diagnosis of depression * History of serious arrhythmia or use of anti-arrhythmics * History of seizures * Subjects with significant co-morbidity, e.g., cardiovascular, respiratory, urogenital, renal, gastrointestinal, hepatic, hematologic, endocrine, neurologic or psychiatric. * Evidence or history of drug abuse within the past 6 months * Erosive esophagitis, esophageal ulceration, peptic stricture, Barret's esophagus, or adenocarcinoma of the esophagus on endoscopy. * History of esophagogastric surgery * Gastric or duodenal lesions (ulcer, tumor, etc) * Women who are pregnant or of childbearing age who are not on contraception * Patients who are unwilling or unable to provide informed consent