My brother is 26 years old and has severe cerebral palsy, he was diagnosed of having gerd and hiatus hernia two years ago.  He has very limited communication and is unable to explain the pain he is suffering.  Over time his symptoms seem to be getting worse, he is on Nexium, Reglan, mebeverine, gaviscon, amitriptiline, lorezapam but nothing seems to be working anymore.  He has had many tests to rule out any other causes to this chronic pain.  My question is can anyone explain whether acid reflux is caused only by eating certain foods or drinks or can this occur even on an empty stomach.  It has been two weeks since my brother has any proper food....but he is in constant pain especially more under his rib cage, 

Any advice would be appreciated.

Thankyou

Sash