Need advice

I have been on PPI's on and off for 10 years.  3 months ago after eating some spicy food and drinking 5hr energy drink my stomach "blew-up" and I have not been the same.  My last endoscope showed gasritis and espogihitis.  I can not seem to get this undercontrol.  My GI says it is not GERD because I am not responding to strongest PPI's.  My main symptoms are sour taste, mild heart burn, burning tongue, hoarsness, mild cough and belching.  I take probiotics and gaviscon, carafate and various others. My GI wants me off PPI's for awhile.  '

For the past 3 weeks I have been on a pretty strick GERD diet but still have issues.  Even though my bed is raised and I have a wedge pillow I still wake up with either acid or bile in my mouth. (I do not eat within 3-4 hours of bedtime).  I do not want the nissen surgury nor am I good canditate for it either.  Any thoughts?  The stuff in my mouth in the morning is whiteish/yellowish foam.  Is this acid or bile.  My gallbladder is good.  My last endo showed gasritis and mild esophigitis.  I am losing hope and going crazy.

Thank you

[Ratnakar Kini, MD]

Hi,
If there is no relief then the following should be taken in to consideration -

1. Take PPI before food for better relief
2. Take PPI twice daily if once daily is not effective.
3. For nighttime pain take ranitidine at bedtime
4. If there is still no relief 24 hours pH monitoring test may be done
5. And finally bile reflux should considered for which the treatment is slightly different.