PPI-s don't work - what does it mean?

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i have been on 20 mg of omeprazole twice a day (40mg total) for a month now - for gerd and esophagitis .

I still get heartburn. what does it mean? 

I am no worse if I just take a Pepcid, perhaps slightly better with the Pepcid. 

I have been taking the prescribed ppi-s so I can complete the treatment for esophagitis; but I need to stop because I still have heartburn, they don't seem to help and I am also worried about the kidneys (had some loss of function over the past couple of years). 

What might be reasons why pips can't stop the heartburn? 

I have been through a lot of stress, anxiety and depression lately. Can a seriously imapired emotional state cause extra acid to the point even PPiS don't work? 


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18 Replies

  • Posted

    Do you think you might need to try a stronger dosage? Like 40mg twice a day?

    also you could try a different brand of PPIs.

    at first I was on Pariet, it stopped working, then I tried Somac, that didn't work - finally I went on Nexium (Omperazole) which worked, however I did have to increase the dosage after a couple of months of being on it, I started on 20mg twice a day.

    • Posted

      They didn't work at all and I am afraid to increase dose to the point these Ned's mess up my system completely. 

      I am concerned that the refluxate might hit be acid but more alkaline...though I do have heartburn. 

      I think my GI needs to do more serious investigation including ph study, mannometry and

      Endoscopy 3 years ago revealed Gerd, HH and mild esophagitis.

      GI says Gerd is mild...but  a new recent transnasal endoscopy I had with an ENT revealed "chronic moderate reflux esophagitis" - at least that's what the lab report said.

      The ENT interpreted it as "gerd without reflux esophagitis", which was truly confusing. He said there was just a bit of redness at the junction but everything else looked good ...and that I shouldn't be on ppi-s. 

      In in the meantime, my gastro wants me on them. 

      I feel like I will soon need another endoscopy to see whether a month of ppi-s did anything to address the esophagitis...because I can't stay on these ppi-s any longer. 

    • Posted

      Some people (me 2) have the bad luck PPI don't work at all.

      ?It could also be that the underlying cause is different in our cases than with other people. In my cause I have TLESRs after eating en drinking, which means whatever I do....there is always some acid (air/food/liquid) coming up.

      ?Wish you all the luck....

    • Posted

      Just wondering how long have you been taking the PPIs? Like Barrett's says it can take a quite a few weeks before they start to work.

      I've had the PH monitoring, I've also had the BRAVO Oesophageal Prosthesis Insertion.

      And none of these testing showed that I had reflux - but I was still having heart burn and I was also diagnosed with Barrett's. But I knew in order to control the heartburn and stop the Barrett's getting any worse I had to take the PPis, pursue with it because I had no other options. And the PPIs did work.

      PPIs are not the enemy! Heartburn is, and also Cancer! If the heartburn is left untreated. It will eventually result with further complications.

      I hope this helps

    • Posted

      I also was diagnosed with Barrett’s last week and gi said I’ll be on Omerprazole 20mg for along term....it does make sense to stop worrying about long term use and focus on the Now. 

      Stop the acid from making Barrett’s worse by ppi’s , diet and trying to be up right as much as possible ..... still get a sick feeling through the day  after being on ppi’s  for months .  Do you think I need a Different kind of ppi?

      What questions should I be asking my dr .  He offers nothing unless I ask 

      Also have follow up servalience endoscopy in 3 years ... I would think they would. Heck my Barrett’s more frequently. I’d hate to get checked Nd they say it’s has dyplasia now..yikes

  • Posted

    Hi syracusa

    I'm afraid ppis didn't work for me either. oTC zantac 150mg twice daily worked much better. Have u tried Zantac?

    Have you adjusted your diet as well. You really must try to avoid all your trigger foods. Do you know what they are? Try to cut out foods that require lots of acid to break down eg meats, sugar and grains and fats.

    At the end of the day I don't think it is a problem with too much acid. For some reason we all have faulty lower eosaphagul spincter muscles. They don't close properly. If you think of a bottle of water, if it is full or almost empty and you Tip it up or shake it around with out the top on water will come out. Now think of the acid in your stomach. You could have a small amount or alot but if spincter muscle is not closing properly and you lie down or go for a run you are still gonna get acid in the oesophagus!!!! But I believe there are different reasons why the LES muscle doesn't close properly and we as sufferers need to find that answer. For some it may be due to a hiatus hernia, for others it may be bacteria (h pylori) or it could be due to small intestinal bacteria overgrowth.

    But what ever the cause I believe it is important to keep the gutt and bowel healthy. We need acid to digest food, that's why I don't agree with long term use of ppis.

    Try and make sure you are eating clean and you are having at least one bowel movement a day. Have you tried probiotics? You may need to try a few before you get right ones. Fermented foods are great too but start small with these and build up slowly. These are great for digestion. I eat a small amount of sauerkraut with my meals.

    Also have you raised your bed. I have two bricks under mine either side. This makes a huge difference. It's not good to prop up with pillows as this can squash stomach and make it worse.

    It's also very important to address your stress and anxiety. I have had to deal with this as well. I'm not a fan of pharmaceuticals but I do take 10mg of lexapro for my anxiety and it has really helped me. I also do yoga and meditation. We are always gonna have stress in our lives so we must know how to cope with it without recking our bodies.

    Good luck syracusa I hope some of this info will help you. Let us know how you get on.

    Dom ?

    • Posted


      I LOVED your explanations. I too suffer and have had a nissen surgery and now the wrap has slipped and going to redo it. But your explanation of the water bottle was awesome. Thank you.


  • Posted

    Heartburn (Acid reflux) has two elements: acid and reflux.

    Oesophagitis is caused by the acid attacking the oesophagus. You need to reduce the acid and the reflux. Acid suppressants are good at reducing the acid but they are not a magic bullet; you need to work with them to control your acid production and reflux.

    Usually 40mg omeprazole (normal high dose) is sufficient to reduce acid sufficiently to allow oesophagitis to heal (over a period of some weeks) for most people. Some people may need more. (I was on 80mg for a few years prior to fundoplication operation. )

    Stress may exarcerbate acid production.

    PPIs are stronger than H2 blockers (eg the famitodine) . If taken correctly (the same time each day - probably half an hour before breakfast being the best) they will restrict the number of proton pumps formed to produce acid and give continued protection. H2 blockers interfere with the signals to produce acid. Typically they are effective for only 12 hours.

    Recent studies that showed a correlation between kidney disease and PPIs did not show a causal link. They showed that those patients with kidney diease are more likely to take PPIs. More people use umbrellas when it rains but the umbrellas don't cause the rain!

    • Posted

      Don't understand all you notes yet - after Prostate R/T result after  one year less than 0.03 Oncologist recommended Ibruprofin - with Warfarin I vomited 4 pints of blood due to ulcers - Consultant rec ommended Omeprazole 80mg a day long term about a year ago3months of worrying head pressure and a bad balance problem - result most of the serious side effects. I have 7cm Barretts due to be diagnosed - I don't have reflux problems other than small tickle. However I have had a 3 month head pressure and bad balance. Have cut down to 40 mg  and then 20 mg a day and pressure and balance have improved by about 85% - When you look at the tablet leaflet the 80 dose is way in excess of what is stated for healed ulcers. I wonder does Gaviscon or similar prvide the ant-acid needed?

    • Posted

      You are assuming peoples reflux is caused by too much acid in which ppi will not help, too little acid must be corrected in a different manner
    • Posted

      Hi Barretts,

      I would like to ask you how was your experience with fundoplication operation. I have to take higher and higher doses of lansoprazole and now I am already on double daily dose and still struggling.

      Would be more than happy if you could share with us our experience with the operation. I read many articles that are not successful long term. Is it true?

      Thank you!!!

      All best,


  • Posted

    Have you been checked for a hiatal hernia
    • Posted

      Yes, I have a small one - dr. said about 2 cm.

      The latest endoscopy showed no herniation, however, the stomach was sitting where it's supposed to. Dr. said it was probably because it was sliding.

  • Posted

    Hello there! Just joined the chat. I am not getting help from ppis... was on omeprazole for 5 weeks and prevacid for 3 weeks. The pain is gone but still sour taste in the mouth. Endoscopy normal. Barium test normal - no reflux found. I tried to drink soda in the morning - no burping. Does it mean I have low pH? Maybe I do not need ppis? What about bile reflux? (I do not have gallbladder) would be grateful for any insights. Thanks!

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