Stomach burning

Dear doctor:  I was diagnosed with GERD last November by endoscope.  I had lesions but no H Pylori, no Barrett's, with reflux to the midline (also had a barium swallow test).  Did not have a hiatal hernia (at least it was not seen by the GI doc).  I was prescribed 80 mgs of Nexium.  It worked well.  I  cut back to 40 mg a day in March.  In June, the refluxing was back with a vengeance.  I reupped my Nexium to 80 mg. again two weeks ago.  I am still having lots of reflux (no acid).  Even water comes back up when I swallow.  I'm also getting burning pain in my upper stomach area. I'm also having lots and lots of stomach gas.

My question is -- can PPI's lose their efficacy after awhile?  I've tried Prevacid and it didn't work.  If they do lose their efficacy, what's the next treatment?

Thanks for your time.

[Ratnakar Kini, MD]

Hi,
PPI is known to lose effect over a period of time. If you do not find improvement with one type of PPI you may switch to another ( Prilosec, aciphex, protonix, prevacid and nexium are th efive approved PPI).
Tke the medications in empty stomach.
In addition certain lifestyle modifications are also essential.
Lifestyle modifications -
1. Head elevation while sleeping
2. Small frequent meals
3. Going to bed 2- 3 hours after food
4. Avoiding bed time snacks
5. Avoiding smoking and alcohol
6. Avoiding tight fitting clothes
7. Avoiding cola, citrus drinks, carbonated drinks, tea, coffee, spicy food
8. Weight reduction