Esomeprazole works well for my acid reflux. How long should I take it?

Hello,

Welcome to icliniq.com.

Well, I appreciate you explaining your symptoms very well and the details about it, which help us discuss the management issues very clearly. Your concern is very valid in terms of the long term use of proton pump inhibitors (PPI).

As you already had an endoscopy, which says evidence of reflux disease, so there is no diagnostic dilemma. Then I think we should discuss the treatment options here.

Since you have responded to PPI, we classify this as PPI-responsive gastroesophageal reflux disease (GERD). The treatment is PPI only if you are not willing for a surgical anti-reflux surgery called fundoplication. There have been many trials compared against PPI in GERD patients, but none proved more effective than PPI.

To answer your concern about the long-term use of Esomeprazole, generally, these drugs are relatively safe and can be used for many years. There are various side effects of note, namely diarrhea, small intestinal bacterial overgrowth (SIBO), causing bloating gas and diarrhea, renal damage, and bone fractures. The last two have been reported after 10 to 15 years of parent compound such as Omeprazole. The data still scarce on other generics like Esomeprazole. Diarrhea and SIBO are somewhat acute side effects, which probably may or may not have been faced now.

To cut the story short, I do not feel significant harm in taking this medicine. Particularly in my practice and in practice across the globe, physicians have rarely seen those reported side effects. I still feel these side effects have been reported for the sake of reporting. And secondly, scientifically speaking, PPI use has been so common in the past few decades that any medical condition like kidney and bone disease (currently the COVID-19 disease) are associated but not necessarily due to PPI use.

I do not think there is any condition that has been masked up to now. If there were anything, this should have shown on endoscopy. You simply have got GERD, and it is very well responding to Esomeprazole.

So to summarize, you need to continue on this for now. Smaller doses like 20 mg of Esomeprazole are fine and should be used without any hesitancy. You had H pylori negative, and given a clean endoscopy and current PPI use, I doubt that you may be developing an ulcer in the stomach.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

The ulcers in the oesophagus usually heal within the first four weeks of use of esomeprazole. I doubt you have any more ulcers remaining in the oesophagus with the continued use of esomeprazole. However, it can be only acid reflux at night, causing you trouble. Because leaning forward or lying supine would cause passive acid reflux from the stomach to the lower part of the oesophagus. Secondly, the half-life of the esomeprazole is 8 to 12 hours, meaning the drug can very well function for 12 to 16 hours, but the remaining 8 hours- the night, the symptoms generally recur. So, Using a second short-term agent like famotidine before dinner is wise. Or you can use the same esomeprazole 20 mg (pantoprazole) at night before dinner. The latter will be more effective than the former. I hope this helps address your concern.

Thank you.

Hello,

Welcome back to icliniq.com.

Famotidine (H2 blocker) will not work if not after meals. PPI and h2 blocker (famotidine) have the best action if not taken half an hour before meals. However, certain medications can be taken right after meals and have good efficiency. the Vonaprazon 10 or 20 mg (lipophilic). This is effective even when taken on a fed stomach. I hope this will help.

Thank you.