Why is my acid reflux worsening despite treatment?

Question

Hello doctor,

My acid reflux has been worsening again. Even small meals cause a burning sensation in my chest, especially when I lie down. I am taking the PPIs that were prescribed, but I feel like they are no longer effective. I have tried avoiding coffee and spicy food and sleeping with my head elevated, but I still wake up at night with a sour taste in my mouth. It is very uncomfortable.

Do people develop resistance to these medications?
I have also gained some weight recently.
Could that be making the symptoms worse?

I read online about a surgical option called fundoplication. Is that something that should be considered? There is concern about depending on medications long-term, but the reflux is significantly affecting sleep.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the concern.

The described symptoms are typical of gastroesophageal reflux disease (GERD). Nighttime burning sensation and a sour taste in the mouth indicate that stomach acid is reaching the esophagus, especially when lying flat.

People do not develop true resistance to proton pump inhibitors (PPIs). However, symptoms may persist for several reasons:

The dose may not be optimal.
The timing of the medication may be incorrect.
The reflux may be more severe.
Recent weight gain may be increasing abdominal pressure.

Proton pump inhibitors (PPI) such as Omeprazole, Pantoprazole, or Esomeprazole work best when taken 30 to 40 minutes before breakfast. In some cases, the dose may be temporarily increased to twice daily under medical supervision if symptoms continue.

Even a small increase in weight can cause increased reflux. Increased abdominal pressure can cause acid to be pushed up into the esophagus. A decrease of about five to seven percent of body weight has been proven to greatly reduce symptoms in many people.

Other lifestyle changes that might assist include:

Avoid eating three hours before going to bed.
Eating smaller meals throughout the day.
Avoid wearing tight clothes.
Avoid late-night snacks.
Limiting alcohol consumption.

If symptoms persist despite correct use of proton pump inhibitors, a physician may:

Adjust the dosage.
Add a bedtime histamine-2 receptor blocker (H2 blocker) such as Famotidine.
Recommend repeat upper gastrointestinal endoscopy.
Perform ambulatory pH monitoring to measure acid exposure.

Regarding surgery, Nissen fundoplication is a surgical operation for certain patients with documented severe gastroesophageal reflux disease that does not improve after optimal medication. This surgery enhances the lower esophageal sphincter to reduce acid reflux. Surgery, however, is an option after diagnosis through adequate testing proves acid reflux in spite of treatment.

Most patients experience significant improvement with correct medication timing, dose adjustment, weight management, and lifestyle modifications. Long-term dependence on medication is not inevitable in all cases, and symptoms often improve once reflux is adequately controlled. Sleep quality typically improves when nighttime acid exposure is reduced.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.