I can only share my own experience. None of my tests were indicating that I had a severe GERD problem, yet while taking 40mg Protonix twice a day (and sometimes additional 300mg Zantac at night, I still needed to have Maalox and Tums always at hand (where ever I went...in my purse, next to my bed, etc.).
My endoscopies were always normal with no evidence of inflammation or Barrett's changes--yet I suffered greatly from breakthrough heartburn, and whenever I took medications that irritated my stomach (like antibiotics), I would get a horrible "lump" mid chest, a feeling of irritation or burning. I had several stomach/esophageal inflammations that took months to resolve, and kept me from eating normally. Actually I would feel full after a very tiny amount of food. This irritation would last for months. However, from all the tests, no doctor would think I was not a candidate for GERD surgery. In fact, I had two GI docs tell me that my GERD was in the "normal" to "below normal" range.
However, my asthma and family doctors were both convinced that my uncontrolled asthma was being caused by GERD. They had pretty much thrown in the towel on my symptoms, and constantly nudged me to go forward with the Nissen Fundoplication surgery. Finally, my family doctor made me an appointment with a bariatric surgeon, who did more tests, and with the additional information provided by my family doctor, said that I was a good candidate for the surgery.
At this point I went back to my GI doc (a second one...I fired the first one for being ineffectual, and not listening to me. He always said that I couldn't be experiencing what I was describing. Hello! I was the one experiencing them. My second GI doc was much more respectful, and listened to me, at least.) He re did the 24hr PH monitor. The results were very average...the number was 14, which isn't indicative of surgery. My first PH monitor came up with a number of 4--and I was told that the GERD was not causing my asthma.
However, with he input of my other doctors, My GI doc thought the option of surgery might work in my case, and help with my horrible asthma symptoms. He even thought that I might be getting bile reflux, which could also irritate my lungs. He sent me to a highly recommended surgeon to discuss that option.
Long story short, I had the surgery, and my lungs have improved markedly. For the first time in probably 4 years (I was actually hospitalized at one point, for asthma caused by uncontrolled GERD brought on by antibiotic treatment.) I could breathe easyly, and was not coughing up tons of mucous from my lungs. My lungs are great now.
I know you're not having lung issues, but I'm telling you my story because it is an example of a GERD problem that didn't follow the "rules"--the tests all looked normal, but it was causing a life-threatening (and extremely uncomfortable) problem.
I wish you lots of luck in finding an answer to your problem.
You know best what you're feeling, and should pursue a resolution. Don't let doctors tell you that you're not experiencing what you know you're experiencing!
This forum is a great place to receive information and support.