Private prescription

I have tried all the others and was put on Nexium it worked. It is one of the expensive tablets I'm not sure where you are but in Australia they're $54 privately but if you have a health care card for people on benefits and pensions it costs $5.40 because the government subsidises them. B

Usually that is generic omeprazole. If you visit www BarrettsWessex org uk and find the Drugs page under the treatments tab, you will find the chart pictured here which shows comparative prices.

All the evidence shows all PPIs are as effective as each other when taken in comparable doses but some patients do find they respond differently to some.

Esomeprazole is controversial (as is Dexlansoprazole).

Ordinary  omeprazole and lansoprazole contain a mixture of S enantiomers and N enaniomers of the drug. (It's a bit of technical chemistry, I'm afraid. The two enantiomers are mirror images of each other but both do the same thing.)

Omeprazole was the first PPI to be produced and Astra Zeneca made a lot of money from it (to cover research and development and more). When it was reaching the stage they would lose copyright on it, they produced esomeprazole (just the S enantiomer) and claimed it was better. They funded research trials to prove it was better. (Except they compared 40mg esomeprazole against 20mg omeprazole whereas most gastroenterologists and pharmacists say it is weight for weight equivalent. Twice as much of the drug would show better results.)

Extensive advertising and agressive marketting in the US where the drugs were immediately made available over the counter without the need for a prescription, lead to esomeprazole (Nexium) becoming a best seller - though no better than cheap generic omeprazole.

When the patent on esomprazole was expiring, the company managed to persuade the British governemnt that Nexium should be available over the counter (as other, less effective, acid suppressants are - eg ranitidine).

The manufacturers of lansoprazole saw the commercial success of Astra Zeneca's action and produced Dexlansoprazole (the N enantiomer of lansoprazole) to make a similar bid. However, they didn't have the same commercial clout as AZ and when they tried to advertise it as better than ordinary lansoprazole the FDA told them it was a false claim.

In US, being available over the counter and being heavily advertised, many people started taking it when an ordinary antacid (eg Tums) would have sufficed. Because they were told it was better, if they didn't se an immediate benefit (eg because they were using them as an on-demand drug rather taking them pre-emptively on a regular daily basis), patients were taking too much.

High doses of PPIs over a prolonged period of time can cause hypochlorhydria (too little stomach acid) that can cause malabsorption of essential minerals and reduction of immunity against bacterila infection. To counter this, the FDA had to issue warnings about misuse of PPIs resulting in osteoporosis, hypomagnesaemia, increased risk of C-difficile. This has ead to PPIs getting a bit of a bad name, particulalrly in US, and people who need to be taking them not doing so.

Sorry about the long preamble. If you have tried all the cheaper drugs on the PPI list and found them all ineffective, you must ask your GP again if he or she will prescribe esomeprazole. (There is now a generic version available.) But GPs are the gatekeepers to the NHS and in charge of the budgets. If they prescribe expensive drugs, it costs their practice money.

If esomprazole is the only suitable drg for you, getting that verified from your gastroenterologist could persuade your GP - or you could try a different doctor?