Nexium stopped working?

[Vicschick]

I had an endoscopy and barium swallow test in November of 2008 and January of this year, respectively.  I had lesions on my lower estophagus, dysmotility of the lower third of my esophagus with reflux to the midline.  I was started on 80 mg of Nexium a day in November of 2008.  In January, I was admitted to the hospital with severe chest pains (I am a woman - 50 yrs old).  They did all kinds of heart tests and it checked out fine.  They chalked it up to esophageal spasm.  I continued with the 80 mg of Nexium until around the middle of February and discovered the Nexium can cause chest pain.  When I cut back the Nexium to 40 mg. a day, the chest pain stopped.  But now, the reflux is back with a vengeance.  I am pretty careful with my diet.

My question is:  Could the Nexium have stopped working?  I am now experiencing pain when I swallow, pain just below my sternum and lots and lots of reflux (but not a lot of acid but I do get a burning throat on occasion).  I'm also getting many more PVC's from the reflux.

[GhostOf1901]

If you've tried all of that and nothing has worked then you may actually be running into another issue: not enough acid. (Turns out about 1/2 to 3/4 of cases of heartburn are caused by this. Strange, eh?) This causes the same symptoms as too much acid, ironically enough. You may want to experiment with apple cider vinegar in that case. (You can find a lot of different recipes online, both on this board and off.) What worked for me for a while was mixing 1 tsp ACV with 2tsp honey and 4 - 8 oz of water. (DON'T DRINK ACV STRAIGHT!!!!!!!!) Doing that for a while helped my symptoms. No promises with this, though, and you may want to do some research before trying this alternative. In the meantime, have you tried going off all your medications? If you do--and even if you don't-- try eating a very, very, very bland, mostly alkaline diet.

Ask your doctor about an esophageal pH study (Bravo 48hr pH study). Esophageal dysmotility, not acid, may actually be responsible for your issues. In addition, make sure to discuss the possibility of surgery if it turns out that too much acid really IS your problem. If you have questions and you feel rushed, explain this to your doctor and make sure (s)he goes over this with you.

Good luck.

[Vicschick]

Thanks so much for your response.  I've not tried doing 80 mg every other day or every third day.  That sounds like a reasonable idea. I have been using Maalox (which gives me diarrhea) and now Pepcid complete.  Not helping at all.  I have an appt. with my GI doc on Monday afternoon.  I've tried Protonix and Prevacid and neither worked.  Maybe its time for Aciphex and we'll see how I do. I'm also of the agreement that I'm probably not a candidate for the surgery because of the dysmotility issue.

Thanks again for your reply.

[GhostOf1901]

The short answer is yes, it can stop working. For some reason the body sometimes becomes resistant to the drug.

That said, are you sure you're not just having breakthrough? If that's the case, consider increasing the dosage for a few days to see how it works, then temper it down (80mg ever 24 hours then every 36, then eventually 40mg/day). Also consider using a supplement like Maalox or Gaviscon in the meantime. If you find that this isn't doing anything more than covering up the symptoms, talk to the doc about switching you to another med, like Prilosec or Prevacid. You should also look into the possibility of GERD surgery (possibly contraindicated due to the motility issues) and alternative therapies like acupuncture and aryuveda.

Good luck.