How to Wean Off PPIs and Why

Heartburn Medication /

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What do you get if you combine the best sleeping position (the left side) and add an incline? The MedCline Acid Reflux Pillow System (wedge pillow).

Do not wean off PPIs or make any changes in use without consulting a physician first! Make sure that you are closely monitored during the process of lowering your dosage of PPIs. It is also important to have doctors watch other medications you may take. The return of normal acid levels in the stomach can change the absorption level of many medications.

Getting off PPIs can cause acid production to increase dramatically.

Doctors and pharmacists recommend slowly weaning off PPIs over a period of weeks to avoid the rebound effect. First, reduce the dosage by 25%-50% each week until taking half your current dosage. Next, taper off further by reducing the intake frequency until you are off the PPI.

After getting off PPIs, there are further recommendations from doctors and pharmacists. If you don’t follow through on these recommendations you could easily end up on PPIs again. Let’s take a further look…

Use Of Proton Pump Inhibitors (PPIs)

According to the American Gastroenterological Association, more than 60 million Americans experience acid reflux monthly, and up to 20% of those suffer from gastroesophageal reflux disease (GERD), a condition of chronic acid reflux.

Heartburn is the pain caused by refluxed stomach acid irritating the esophageal lining. Antacids are usually sufficient in treating the majority of heartburn sufferers, but those with GERD are frequently prescribed a Proton Pump Inhibitor (PPI) by their primary care physician or gastroenterologist.

Common PPIs include:

  • AcipHex (rabeprazole)
  • Dexilant (dexlansoprazole)
  • Kapidex (dexlansoprazole)
  • Losec (omeprazole)
  • Nexium (esomeprazole)
  • Prevacid (lansoprazole)
  • Prilosec (omeprazole)
  • Protonix (pantoprazole)
  • Rapinex (omeprazole)
  • Vimovo (esomeprazole, magnesium, and naproxen)
  • Zegerid (omeprazole and sodium bicarbonate)
PPIs reduce or eliminate the pain associated with GERD by blocking the stomach’s production of acid, thus lowering the acid level in the stomach that might reflux into the esophagus and irritate the lining. There is no question about it. PPIs can be used effectively to help in the healing of ulcers, acid damage, and with antibiotics from Helicobacter pylori,1 but is it the right choice for the treatment of your condition?

Get Off PPIs in 5 Steps:

  1. Gradually reduce the dosage by 25%-50% each week until you are taking half your current dosage. Wean off PPIs slowly to reduce the likelihood of acid rebound.
  2. Reduce intake frequency. If taking 2x daily, take once a day for a week. When at once a day, step down to every other day for a week.
  3. Change to an H2 blocker and wean down from H2 blocker to antacid using the same steps as in 1&2.
  4. At this point, occasional heartburn can be treated with antacids and an H2 blocker when necessary.
  5. Lifestyle and diet changes should be permanently maintained.

For the complete details on weaning off PPIs and the 5R Program for lifestyle modification, please read the complete article.

Misuse Of PPIs

While PPIs provide relief, they do not cure GERD. They only mask the problem by removing the pain associated with heartburn. If the medication is removed, the symptoms are likely to recur, thus proving this to be an ineffective treatment for GERD.

The only way to cure GERD is for the sufferer to take an active role in managing the disease through a lifestyle change.

Too many of us take the easy way out and do not take care of ourselves as we should. Eating healthy foods in proper proportions, limiting alcohol, and being physically active are some of the basic lifestyle changes that will eliminate GERD for most people.

Many who suffer from heartburn take PPIs without fully understanding how they are to be used. This is partly due to the lack of self-education on the part of the patient and a failure on the part of many caregivers to provide patients with proper instructions on how to take the drug.

This lack of knowledge and fact that many PPIs are available as over-the-counter (OTC) medications lure patients into a false sense of security in the drug’s safety.

Too many patients continue taking PPIs for months or years because they do not understand the risks.

In the United States, the packaging on OTC PPIs clearly directs taking it for no longer than 14 days or more often than every 4 months unless directed by a doctor.

This duration is to prevent negative side effects that can occur when using the medication long-term. Though your doctor may prescribe you a PPI for a different time interval depending on your health issue, they are meant to be taken short-term and in the lowest dosage and interval possible to achieve the desired effect while healing from acid irritation takes place.

Long-term or large-dosage use of PPIs for GERD, acid reflux, or heartburn is a poor choice for those without severe symptoms. PPIs are valuable in the short-term treatment of GERD, but long-term use may lead to the following health issues:

  • Increased risk of a heart attack.2
  • Increased risk of pneumonia.
  • Bacterial infections introduced through foods.
  • Increased risk of a Clostridium difficile infection.3
  • Decreased absorption of vitamin B12, calcium, magnesium, iron, and other nutrients leading to bone fractures, hypomagnesemia, and cardiac arrhythmias.4,5
  • Reduced ability of the lower esophageal sphincter (LES) to close due to low stomach acid levels. Higher acid levels are needed to induce the proper closure of the LES.
  • Increased risk of Barrett’s esophagus which can lead to cancer.6
  • Increased risk of esophageal cancer.
  • Increased risk of chronic kidney disease.
  • Increased risk of liver damage.
  • Increased mortality risk.

[For greater details on long-term use, side effects, and an understanding of the use of PPIs in treatment, please see the post “PPI – Proton Pump Inhibitor“.]

5 Reasons For Weaning Off PPIs

  1. Long-term use of PPIs increases the risk of heart attack, kidney disease, liver damage, mortality, and more.
  2. If you are exceeding the recommended dosage for PPIs, you are outside the FDA guidelines and are at risk of serious health issues.
  3. If you initiated PPI medication without a doctor’s recommendation and supervision. Though PPI medication is available in OTC form, PPIs should not be taken without a doctor’s recommendation.
  4. If you are taking PPIs for regulating occasional acid reflux symptoms like heartburn… PPIs are not intended for the treatment of occasional acid reflux symptoms. Their best use is for stomach acid reduction to allow healing from acid erosion. There are other OTC heartburn medications better suited for treating acid reflux symptoms.
  5. If you are breastfeeding, pregnant, or may become pregnant. PPI medication can expose the baby to risk.7
Graphic listing the five reasons for stopping PPI use. The reasons can be found in this article.

What Are The Side Effects Of Weaning Off PPIs?

The body is designed to produce stomach acid and will compensate for the drop in acid levels when using PPIs. Rebound acid hypersecretion can occur when there’s sudden discontinuation of PPI medication.

In studies, this discomfort from over-production of acid affected 44% of patients lasting from one to three weeks.

The rebounding of acid seems to be related to the degree of acid suppression.8,9 Therefore it is important to understand that this over-production of acid can occur, to be prepared for this possible side effect, and to slowly lower levels of your PPI when you wean off in order to minimize this problem.

Steps For Weaning Off PPIs

A. Understanding The Process Of Weaning Off PPIs

1. You should consult with a physician before making any change in PPIs and before implementing the 5R Program for Lifestyle Modification listed below. Your doctor can determine if these health steps are right for you. We are all different and modifications might be needed to accommodate your health conditions and any medications you may take.

2. Do not attempt to wean off your PPI if you are being treated for ulcers, acid damage, Helicobacter pylori, or other condition where PPIs are needed for treatment. Your doctor can help you make this determination.

3. The return of normal acid levels in the stomach can change the absorption level of other medications you take.

4. If medications are controlling your symptoms you may be able to reduce the dose of PPIs you’re on or wean off them altogether. GERD patients are often prescribed PPIs in dosage and frequency higher than needed. We are all different and the doctor is only making an estimate of what amount you might need to control your symptoms. If you are one of the many who’ve been overprescribed PPIs, symptom control may be achieved at a lower dosage, frequency, or even with a less potent form heartburn medication like an H2 blocker.

5. There are 3 levels of heartburn medications. They control the symptoms of heartburn but do not cure the underline cause of heartburn. If a lower dosage of PPIs or a lower level of heartburn medication can treat your symptoms, it is important for your health to find the minimum level of treatment while still controlling heartburn.

  • Level 1: Antacids help neutralize stomach acid. They act quickly but are short-lived, usually less than 2 hours. They are great for combatting the occasional heartburn brought on by ingesting heartburn trigger foods or drinks.
  • Level 2: Histamine receptor blockers (H2 blockers) decrease stomach acid production, thus decreasing heartburn due to acid reflux. H2 blockers can provide up to 12 hours of relief.
  • Level 3: PPIs are used when antacids and H2 blockers aren’t providing relief. It may take days before they start providing relief, usually 48-72 hours.

6. We must understand that GERD is not caused by too much acid, but by acid being refluxed into the esophagus where it does not belong. Stomach acid can reflux when the LES doesn’t close properly. Acid is actually needed. It just needs to be in the stomach where it belongs. Acid triggers the LES to close keeping the acid out of the esophagus. Certain foods, overeating, abdominal pressure, medications, alcohol, nicotine, and obesity are the main offenders that can affect an otherwise properly functioning LES. These offenders can impair the lower esophageal sphincter’s ability to close properly allowing acid to reflux into the esophagus.

7. Lifestyle choices are tied to GERD in most cases. A positive change in diet, exercise, and stress levels will be required to wean off PPIs. This also includes a reduction in weight for many which will likely occur when the change in diet, exercise, and stress management are implemented.

8. It is important to make small gradual reductions when you’re weaning off PPIs.

9. Many are fortunate and can easily lower PPI dosages. Others are not as fortunate. Weaning off PPIs is not possible for those whose disease has progressed too far. These people will have to stay on PPIs. Remember PPIs do not cure GERD. They only mask the pain. GERD can still progress while taking PPIs. The goal when unable to stop taking PPIs is to find the right level of medication for your health and well-being and no more.

10. We are all different. What works for one may not work for another. It is important to take it slow and step back if your symptoms substantially increase.

11. It will be easier for people with less severe GERD symptoms to wean off PPIs and also easier for those who have taken the drug for a shorter time period and at a lower dosage than those with more severe issues who have taken high dosages for many years. There are even a significant number of long-term users taking PPIs for GERD who were misdiagnosed and don’t even need to be on the drug. This is primarily seen in those who did not have an endoscopy performed proving erosive esophagitis or a positive pH test. Weaning off PPIs will be easiest for those who were misdiagnosed.

12. Keeping a heartburn journal during this time will help you understand your triggers and any setbacks you have while you wean off PPIs.

13. The ultimate goal of this program is to wean off PPIs and return the stomach to proper function.

B. 5R Program For Lifestyle Modification When Weaning Off PPIs

If you have a proven diagnosis of GERD and have not changed your lifestyle, you will still have GERD when you wean off your PPI. This is because PPIs do not cure GERD. They control the pain of heartburn by reducing acid irritation. Heartburn will return if lifestyle changes aren’t implemented. GERD can only be corrected through diet, exercise, and stress management.

We can address the treatment of GERD by addressing the 5Rs of functional medicine: remove, replace, repopulate, repair and rebalance. Depending on your overall physical condition, the 5R Program should be in place one week to a month before you begin weaning off your PPI. Stomach acid is needed to properly break down food for absorption, so the dietary changes will become additionally effective when the stomach is back to producing acid at its optimal level.

1. Remove

Remove as many of the following heartburn triggers as possible…

Heartburn Trigger Foods

Remove heartburn trigger foods like processed food, fried food, fatty meats, dairy products, spicy food, the allium family (garlic, onions, shallots, leeks, and chives), tomatoes, acidic fruits, alcohol, coffee, caffeine, carbonated beverages, mint, chocolate, and candy containing acid in any form.

Foods you are allergic to may also cause you heartburn and should be avoided.

It would be good to keep a heartburn journal to log any other foods that might trigger your heartburn. We are all different and some food might cause you problems where they wouldn’t someone else. Heartburn trigger foods should be avoided because they can cause increased acid, irritation, and weaken the closure of the LES.

Excess Weight

Most of us could stand to lose a little weight around the middle. Excess weight causes pressure on the LES.

Tight Clothes

Avoid tight-fitting clothes around your waist and stomach to prevent added pressure on the LES.

Poor Eating Styles

Do not overeat and smaller meals are best. Consider 4-5 small meals spaced throughout the day instead of the typical three. Eat slowly and chew properly. Putting the utensils down after each bite helps slow down eating. Following these eating guidelines will help aid the digestion process, let us know when we are full, and help us relax.

Poor Positions

Remain upright during the day. Reclined and slouched positions cause stomach contents to press on the LES.

Nighttime Heartburn Triggers

Remove nighttime heartburn triggers by fasting 2 or more hours before bed, sleeping with your torso elevated by placing six-inch bed risers under the head of your bed, or by using a wedge pillow system or a bed wedge pillow will help stomach acids from refluxing, and lying on your left side which allows the stomach to hang lower thus preventing its contents from placing as much pressure on the LES.

Related Content: Elevation Therapy For Heartburn At Night: Time To Sleep On An Incline

Tobacco and Nicotine

Tobacco and nicotine include smoking tobacco, chewing tobacco, nicotine patches, and nicotine gum. These products cause irritation and relaxation of the LES along with other heartburn-producing side effects.

Related Content:


OTC and prescription medications along with supplements may cause heartburn. It’s best to consult your doctor to see if some heartburn-producing medications can be taken in the morning or hours before bedtime to reduce the chances of nighttime heartburn.


Learn how to de-stress.

2. Replace


When the heartburn trigger foods are removed, we are left to eat more nutritious foods which will boost our overall health and help us maintain a healthy weight.

Vitamins and Minerals

PPIs cause deficiencies in vitamin B12, iron, calcium, and magnesium. Supplements may be needed to raise your levels of these.


Consider taking a betaine hydrochloride supplement (Betaine HCl). Some people benefit from adding acid. Stomach acid aids in the proper function of the LES breaks down food and stimulates digestion. Avoid any betaine hydrochloride supplement containing NSAIDs or steroids. They can damage or irritate the digestive lining.

3. Repopulate


Low stomach acid levels can allow unhealthy bacteria to flourish in your gastrointestinal tract. Consider taking probiotic supplements and ingesting fermented food or drink containing probiotics to reintroduce them into your system.


Prebiotics are nondigestible carbohydrates that serve as a food source for probiotics. Prebiotics are available as a prebiotic supplement and in many foods such as artichokes, asparagus, bananas, barley, beets, carrots, flax, garlic, leeks, legumes, oatmeal, onion, radishes, wheat, and more.

4. Repair

Mucilage is a thick, gluey substance found in plants that help coat and build up the mucous membrane of your gastrointestinal tract to protect against acid and promote healing. Take one or more of the following forms of mucilage. If you are experiencing esophageal irritation, make sure to take a form that coats the esophagus and not take the capsule or tablet form.

Popular forms of mucilage for repair are:

  • Licorice in deglycyrrhizinated form, DGL.
  • Aloe vera reduces inflammation and irritation. It also promotes healing, though it can serve as a laxative as well, so watch how much you take. You might look for some with the laxative component removed. Aloe vera can be purchased in a number of forms: juice, gel, powder, and softgels. Only use forms of aloe that are prepared for internal use.
  • Slippery elm
  • Marshmallow root
  • Throat Coat Tea (Traditional Medicinals) contains licorice root, slippery elm, and marshmallow root.

Related Content:

5. Rebalance

Decrease stress

Stress can increase sensitivity to acid and should be managed through exercise, enjoyable activities, soothing music, aromatherapy, meditation, prayer, massage, pets, friends, sex with a partner, laughter, sleep, etc.


Make sure you’re performing exercises that reduce heartburn risk and wait two or more hours after eating to avoid added pressure on the LES.

C. The Process For Weaning Off PPIs

There is no infallible way to know if you will be able to decrease or wean off PPIs without trying.

We are all different and have to be treated as such when making medical choices. This is the main reason why it’s important to have your doctor approve and monitor your progress when weaning off PPIs. That said, weaning off PPIs has been successful in the majority of patients.10

If you have a rebound of heartburn during the PPI taper schedule, back up in the process and take it slower. Also, consult your physician.

The basic steps to wean off PPIs:

1. Gradually reduce the dosage by 25%-50% each week until you are at 25%-50% of your current intake. If you go at 50%, this will take one week. If you go by 25%, this will take 3 weeks. The slower you wean off PPIs the less likelihood of acid rebound.

2. Once you are at a low daily dose, reduce the frequency at which you take the drug until you are off the PPI. If you are taking the PPI twice a day, step down taking it once a day for a week. When down to once a day, step down to taking it every other day for a week. If heartburn becomes severe, in either or both of these steps try substituting an H2 blocker where you once took the PPI.

3. Step down to the use of an H2 blocker and/or antacid once the above two steps have been completed. Though H2 blockers don’t have the severe side effects PPIs have over the long term, it is healthy to keep weaning down from H2 blockers to antacid use alone.

Weaning off h2 blockers… Taper off the H2 blocker over the next 2-4 weeks using similar steps to those above.

4. At this point, you should be able to treat the occasional heartburn on-demand with antacids or with antacids and H2 blockers when necessary.

5. Once you have weaned off the H2 blocker you may find you have no need for the mucilage. You can stop taking it or wean off of it as well.

D. Maintenance After Weaning Off PPIs

Remove and Rebalance, the first and fifth Rs of the 5R Program for Lifestyle Modification will have to be adhered to throughout your life to prevent GERD from recurring. The other three Rs need to be revisited where necessary. If you are adhering to the steps of Remove and Rebalance and heartburn becomes more frequent, revisit the other three.

In the Maintenance phase after weaning off PPIs, you should be able to take antacids or antacids and H2 blockers when necessary. You may also find natural heartburn remedies helpful. Don’t be discouraged if the occasional round of PPIs is needed in the future. When taking future dosages of PPIs, adhere to the acceptable amount recommended by the FDA taking it for no longer than 14 days or more often than every 4 months. Remember to always take the lowest level of medication you can while keeping your symptoms at your level of satisfaction.

Conclusion of How to Wean Off PPIs and Why

Getting off PPIs isn’t easy. Don’t rush the process when weaning off PPIs. Remember, the longer you have taken PPIs the longer you should take weaning off to prevent an overproduction of acid. We are all different so consult your doctor before weaning off PPIs. Some people need to take them for longer periods of time than others.

Purple pills. Graphic states... How and why to wean off PPIs (proton pump inhibitors).


1) Jai Moo Shin, PhD, & George Sachs, DSc, MD. “Pharmacology of Proton Pump Inhibitors.” National Center for Biotechnology Information, U.S. National Library of Medicine, Current Gastroenterology Reports – Springer, April 15, 2010.

2) Shah NH, LePendu P, Bauer-Mehren A, Ghebremariam YT, Iyer SV, Marcus J, Nead KT, Cooke JP, & Leeper NJ. “Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population.” National Center for Biotechnology Information, U.S. National Library of Medicine, PLOS One, June 15, 2010.

3) “FDA Drug Safety Communication: Clostridium difficile associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs).” U.S. Food & Drug Administration, March 23, 2011.

4) “FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors.” U.S. Food & Drug Administration, September 24, 2015.

5) “FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs).” U.S. Food & Drug Administration, March 2, 2011.

6) Omran Alsalahi, & Anca D. Dobrian. “Proton Pump Inhibitors: The Culprit for Barrett’s Esophagus?.” National Center for Biotechnology Information, U.S. National Library of Medicine, Frontiers in Oncology, January 9, 2015.

7) Majithia R, & Johnson DA. “Are proton pump inhibitors safe during pregnancy and lactation? Evidence to date.” National Center for Biotechnology Information, U.S. National Library of Medicine, January 22, 2012.

8) Christina Reimer, Bo Søndergaard, Linda Hilsted, & Peter Bytzer. “Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy.” Gastroenterology, July 2009, Volume 137, Issue 1, Pages 80–87.e1.

9) Anna Niklasson PhD, Lina Lindström MD, Magnus Simrén MD, PhD, Greger Lindberg MD, PhD, & Einar Björnsson MD, PhD. “Dyspeptic Symptom Development After Discontinuation of a Proton Pump Inhibitor: A Double-Blind Placebo-Controlled Trial.” The American Journal of Gastroenterology, March 23, 2010.

10) John M. Inadomi, Roula Jamal, Glen H. Murata, Richard M. Hoffman, Laurence A. Lavezo, Justina M. Vigil, Kathleen M. Swanson, & Amnon Sonnenberg. “Step-down management of gastroesophageal reflux disease.” Gastroenterology, November 2001, Volume 121, Issue 5, Pages 1095–1100.

109 Replies to “How to Wean Off PPIs and Why”

  1. Hi Steve,

    I’ve been on PPI’s for 30 years (since 1990). My Doctors never explained the damage these drugs could cause long-term and the living hell they can cause due to a decrease in nutritional absorption. I tried to go off cold-turkey without a doctor’s help back in August 2019 because I could trust them no longer. I was using CBD oil and supplementing with Betaine HCL at the time, and 1 month later, I found myself throwing up blood and rushed to the hospital with an esophageal ulcer. This is stuff is not to be messed with when coming off them, so thank you for this article. It’s been a long way back to healing up my ulcer, but I am now getting off the PPI’s under a doctor’s care and I’ve been able to get down to 20mg of Prilosec every other day from 40mg of Esomeprazole 2x/day over the span of 1 month, but am now experiencing some rebound here and there. It’s strange, but I actually feel a lesser or equal amount rebound when I DO NOT take the medication as when I do, is this odd? I feel rebound anywhere from 2-4 times a day, and it lasts a very short time, anywhere from a few seconds to 15 seconds or so, but no more. Eating something helps, drinking apple cider vinegar (1 tbs. in 6-8 oz. of water) helps also. I do get concerned that my ulcer may come back as I had like no symptoms except an occasional rebound like I do now when it started to bleed out. Do you think I should stop the every other day thing, and start on the H2 blockers every day for a while? Where do you think I am at in your protocol? Any suggestiosn for someone like me?

    Thank you so much for this article!

  2. Hi Steve. I was reading your article regarding weaning off Prilosec. Have been on it for a long time and was experiencing extremely dry mouth at night during sleep. It got to a point where I would wake up with my tongue stuck to the roof of my mouth. After much investigation into the various meds I am on [Mobic 15 mg., Valsartan 40 mg., Zetia 10 mg., Vit B12 and Vit D3], I decided the Prolisec was responsible for my dry mouth. I weaned myself off, from 20 mg. twice a day to 20 mg. daily, then every other day. Used antacid PRN and Pepcid occasionally. My dry mouth is much better, but not completely gone! I actually have spit again at night! Am I on the right track??? Today, I actually have not experienced any GERD. I would occasionally thruout the day and would take a shot of antacid. I know “dry mouth” is not a predominant side effect, but medications affect everyone differently.

    I know I need to make diet changes and lose some weight. I have an app at the Y this coming week for a program to start. I have to do this gradually bc I am 70 years old. I am a retired nurse and when a medication starts to affect me in an adverse way, I start investigating.

  3. Hi Steve –

    Thank you for this helpful article! I am slowly weaning off of 40 mg omeprazole after 2 months of use (for pill-induced esophagitis – never had any reflux/upper GI problems beforehand). I am down to 10mg and am now experiencing acid rebound at times – is this to be expected even before I have discontinued the medication? My next step will be to introduce Pepcid 2x/ day every third day per my doctor’s instruction, and I’m a little nervous being that I’m still on 10mg daily and already feeling some rebound. I’ve read different things on different websites about the length of time acid rebound lasts after discontinuation. How long can I possibly expect to feel acid rebound after I stop the medication? Will the rebound most likely go away?

    1. Hello Eve, the rebound effect caused by omeprazole use will go away. The amount of time varies. Typically, the longer a patient is on PPIs longer the recovery. Occasional heartburn is normal but you shouldn’t have chronic heartburn after getting off omeprazole if your doctor has helped you overcome the underlining problem leading to the use of omeprazole. Pepcid should help with the acid rebound. I used the generic version of Pepcid when I weaned off omeprazole.

  4. As a starting point is it safe to alternate between 20mg and 40mg daily as a way to step down from 40mg a day?

    I started doing this last week and already the pain is bad, I would of never been able to just stop as my doctor advised!

    I have been taking 40mg esomeprazole since last September.

    Thank you.

    1. Hello Jim, This is a question you’ll have to ask your doctor or pharmacist. Ask about the possibility of taking an H2 blocker and or antacid while getting off esomeprazole. Some doctors approve of this route some do not. Everyone is different. That’s why you need the guidance of your doctor. There are natural remedies like DGL and slippery elm. These will help reduce heartburn by coating and protecting the esophagus.

  5. Hi Steve
    I have been off of PPI for one year now (after 14 year routine for Schatzki Ring. )After reading up on PPI’s I quit taking them. Over the year I have had occasional acid reflux issues but have managed ok. However, I still struggle with stomachs ACHE. Dull, uncomfortabliity. My stomach feels like a gas bubble and I frequently have little burps, regardless of whether I have eaten anything.
    I drink about 1tbsp apple cider vinegar daily.
    I am hit and miss with my probiotic pill.
    I chew DGL licorice once or twice a day for healing gut.
    I have started eating only between 11am and7pm to reduce time I have food in my stomach.
    My GP just gave me a requisition to test for H.Pylori and I am on the wait list to see a Gastro specialist to check up on the status of my esophagus.
    Do you have any thought as to why I have this constant dull ache, with gas burps a year later? I can’t find any info regarding this issue.
    Thanks for any info you can provide.

  6. Hi Steve, I have been suffering since early this year with what started as lump in throat and progressed to feeling a furball in throat and more of a sore/burning feeling at base of my neck right above clavicle. I’ve had more traditional “heartburn” (in chest) in the past but haven’t had that this time, except beginning in last couple of weeks. I’ve been taking Prevacid 30 mg in AM, and an H2 blocker in evening, and it hasn’t seemed to make any difference. In my case I think this is all linked to perimenopause due to the effects my cycle has on the symptoms. An ENT dr. looked at my throat in June and saw nothing. I had a normal endoscopy about a year and a half ago but that was when I was having a spate of more standard “heartburn” symptoms, and not to the extent (daily) I have these problems now. The worst thing for them seems to be drinking water, at any time other than at least 3 hrs. after meals. So I have wondered if the problem is slowed esophagus or gastric emptying as I can also feel full quickly. I tried many different digestive enzymes, but no luck. DGL made my heart race; slippery elm soothes but finally did not solve problem. My latest thought has been to try Gaviscon Advance from UK which DOES help a lot especially at night, but it’s hard for me to take it after every meal because I do at some point need to drink water, take other pills, etc. and the timing gets complicated. Actually my main question is whether the acid-blockers I am still taking are making the Gaviscon not work as well. I read somewhere that the alginate needs to combine with the acid in your stomach to form the raft. I am thinking of dropping the Prevacid dose to 15 mg (I would love to get off it anyway) and trying to see if I can take the Gaviscon 4x/day, but I am nervous about doing this when symptoms have been so bad. The other option would be a nighttime PPI dose just to get things under control, THEN wean. I guess I may have to do that but would really rather not! Any thoughts? (OH, and I have also majorly changed what I eat and all that, no alcohol, no caffeine, no acidy things.)

    1. Hello Jen, it sounds like you’re on the right track by trying to find the root cause of your acid reflux issues. The acid reducers will just mask the problem. I can’t answer your Gaviscon question. Are you taking anything for hormone replacement? Augmenting estrogen and progesterone through hormone replacement therapy can cause acid reflux. You mention other pills. There are many medications that can cause acid reflux. If possible, adjusting the time you take these medications may help reduce your acid reflux symptoms. Taking them in the morning may help reduce your chances of nighttime heartburn. Talk with your doctor and pharmacist before making any changes to how or when you take medications. There may also be a substitute medication that works better in your circumstance. If your problem is slowed digestion, there are medications that can speed up the process.

  7. Hi.
    I was taking 20mg omeprazole every day for 8 months. In the last month I got a campylobacter infection and was very sick.
    I decided to stop taking the omeprazole and was advised by a Dr that it would be fine to do so.
    I then got better.
    A few weeks later I was sick again.

    Blood and stool samples all clear and no idea what’s wrong with me.

    I’m starting to wonder if it was stopping omeprazole.

    My symptoms now are..
    Weak and very fatigued.
    Gurgling stomach but regular BM
    Slightly numb or heavy left arm.
    Panic attacks and mood swings

    Can you help?
    Should take omeprazole again and then wean off it or just ride out the symptoms?

    It’s unbearable.

    Hope you have some advice.

    Thank you in advance.

    1. Hello Chris. You need to immediately see your doctor about the numb left arm which can be a sign of a heart attack. Omeprazole can cause nausea and low magnesium which can lead to dizziness. Omeprazole causes low stomach acid. Campylobacter and other bacteria are sensitive to hydrochloric acid in the stomach. When you reduce stomach acid you hinder the body’s ability to defend itself against bad bacteria. Bacterial and yeast infections can cause digestive disorders as you have described along with mood swings. Many people need to take PPIs for certain GI problems. Others take them unnecessarily. Your doctor needs to help you diagnose the problems you’re having.

    2. I was on omeprazole and tried to stop and got the same side effects as you have, very scary. Tried to stop two times now and the symptoms that you are describing start around the third week of cessation. I have been on omeprazole for a year before trying to stop, my stomach and duodenal is fine and the gastro enterologue told me I could stop omeprazole. I am wondering if I stay at the same dosage for 6 weeks prior lowering again and 6 more weeks etc. would that work better? The anxiety is really bad and very painfull spasms which help when I take an anti-anxiolitique, but can’t take those for a long period because of possible addiction. Omeprazole should not be prescribed, this is almost an impossble drug to get rid of after months of usage.

      1. Hello Linda, ask your doctor if they think you should take an H2 blocker while you taper off Omeprazole. If it’s esophageal spasms you’re having, your doctor needs to know about them as well.

        1. Thank you Steve, it seems to be both intestines and stomach/esophageal spasms, 20 minutes after I take a small dose of clonazepam the muscles spasms seem to resolve and the anxiety is under control. I was at 10mg for a month and then 5mg for two weeks and then stop, was not bad for the first 3 weeks, a bit of dizziness, a bit of anxiety but tolerable until the 3 weeks, I tried to endure a week and a half more thinking it will go away it is rebound, but than panic attack started and insomnia, painful spasms. I had to take back 15mg and it took 16 days to stabilize, now I am trying to get to 10mg again and I have anxiety, wow. Incredible, I never thought it would be so hard stopping a medication. I will talk to my doctor regarding H2 blocker. Is it hard to taper off H2 blockers?

  8. Hi Steve.
    I was put on Pantoprazole Sodium Ec 40 Mg 9 days ago. I was not feeling acid reflux symptoms but GI doctor told me I have slight acid reflux after an endoscopy. What would be the weaning process after being on it for 9 days? Thank you very much for all the helpful advice you’ve given us all. It is so very appreciated!

    1. Hello Tina. Great hearing from you and thank you for reading! Please speak to your pharmacist or doctor. They can better advise you. Your situation may be different than mine. I was on and off PPIs for years. From my personal experience, I had no noticeable acid rebound when taking PPIs for as little as 9 days and stopping without tapering off. I’m glad your GI doctor didn’t find anything more than the slight acid reflux. Have a wonderful day!

  9. Hi Steve

    I was on Omeprazole 20mg for 6 months, I stopped taking them cold turkey after they were making me feel very sick, I switched to Zantac 150mg only at night, its been 2 months and I am still feeling rebound symptoms during the day. How long does it take and if I stop taking Zantac is there another rebound from them. If I don’t take a Zantac at night I don’t have heartburn but feel sick and very acidic which is made better after eating food.


    1. Hello Christian, You should see your doctor about your symptoms. Acid rebound from getting off PPIs can vary. Rebound symptoms from the Omeprazole may not be your problem. Are you following the 5R Program For Lifestyle Modification during this process? It is necessary for most people to change their lifestyle to overcome GERD… There should not be a rebound in acid when stopping Zantac. Hope your acid reflux symptoms are history very soon!

  10. Hello Steve,

    I have been on 20mg of omeprazole 2x a day for the last 4 years. My gastrologist performed an endoscopy a few years ago and found nothing, However, she still recommended 20mg 2x a day. After doing a lot of reading on the effects of long-term PPI use I am determined to wean myself off. I started about a week ago by taking my morning 20mg of omeprazole and then replacing my nightly dose with Maximum Strength Zantac 150. So far this seems to be working, I’ve also purchased Deglycyrrhizinated Licorice, but have not used it yet as I am not sure the best way to work it in weaning off of omeprazole. Would my next step be to take 20mg every other day and taking Zantac in its place? Thank you, this article has a lot of great information.

    1. Hello Michael, You are welcome! The DGL can be taken 20 prior to meals to prevent heartburn symptoms. It also helps to take it when you have heartburn… The outline in the article provides steps for tapering off PPIs that you can discuss with your doctor. It’s best to talk with your doctor about tapering off omeprazole. When I got off PPIs, I reduced my dose to 10mg 2x a day before I dropped to once a day. I did take Zantac 150 in its place and antacids when needed. Some doctors do not recommend taking an H2 blocker or antacids with PPIs. Again, it’s best to speak with your doctor to see what they recommend for your situation. I also took my PPI at night when I dropped to once a day. Acid reflux is usually worse at night. I hope that helps give you a clearer path. If you end of having too much pain from the rebound in acid, back up a bit and take it slower. Wishing you the best during the weaning off process and beyond. It sounds like you’re off to a great start. Keep in touch. Looking forward to hearing when you have met your goal!

  11. So now I’m confused. I started a 20 mg Nexium treatment (on the recommendation of my pharmacist, while waiting to get into my GP) 6 days ago after 6 reflux attacks in 3 weeks. Saw GP yesterday who told me to drop Nexium and put me on 40 mg Tecta for the next 8 weeks (no tests, just questions to rule out cardiac issues). When filling the prescription, a different pharmacist (same pharmacy) basically told me the GP shouldn’t have put me on Tecta for 8 weeks and that I’ll have rebound acid when I finish.

    What should I do?

    1. Hello Claire, if you’re having heart issues, you need to be seen by a cardiac specialist and if you’re having GERD issues it’s best to see a gastroenterologist and possibly a nutritionist that can review your diet. A second opinion couldn’t hurt. From my understanding, eight weeks on Tecta is the typical duration prescribed for the healing of an ulcer. Yes, you are likely to have acid rebound after the eight weeks. PPIs are useful at times and are great when there’s a need for healing from ulcers or other acid erosion.

      GERD is the occurrence of acid reflux two or more times a week. Heartburn drugs like PPIs do not cure acid reflux. They only mask the symptom of heartburn by blocking acid production. In most cases, it can be eliminated by diet and lifestyle changes. I found what, when, and how much I ate to be the main causes of my GERD problems. It’s different for everyone and we have to pinpoint the source of the issue. My wife found that her GERD issues were linked to gluten intolerance… Hope you are better soon! Hang in there!

  12. Hi Steve, I was put on omeprazole 3 weeks ago after experiencing burning in my throat and chest. I believe this was a result of being on an antibiotic which tore up my stomach and then a couple weeks later a steroid. I would like to stop the 20mg of Omeprazole and find a more natural way for dealing with this. I did not have any of these issues before the antibiotic and steroid. I still get some burning in my throat currently and feel very bloated. Do you think it would be ok to just stop taking it since I have capsules and cant really half those and would I start with the DGL or use digestive enzymes and Betaine HCL? I am also on Carafate 4x a day. Thank you!

    1. Hello Elaine, I’m sorry to hear about your troubles. I’m not able to give you specific medical advice. You will need to ask your doctor about that. I can say that DGL and digestive enzymes are generally considered great options. The DGL can help coat and protect against refluxed acid and the digestive enzymes can help reduce bloat… Since you’ve been on omeprazole 3 weeks you’re less likely to have a great issue with acid rebound, though you may experience some problems. If you’re experiencing acid rebound, your acid levels would be high and Betaine HCL would not be needed. If your underlining issues are caused by low stomach acid levels, Betaine HCL would be a good choice. Natural healing methods can work, unfortunately, not all supplements or lifestyle changes work for everyone. We’re all different and our underlining issues, which can be many and varied, are also different. Since you were not having issues before taking antibiotics and steroids, diet including the replenishing of good digestive bacteria may be all you need in the long term. Thank you for reading and commenting. Hoping you feel better soon!

  13. Hi,
    I have been trying to get off 40 mg a day by taking one every other day for the last week. I don’t know if it is coincidental or a possible side effect from the reduction but have noticed allot of gas in my intestines and some diarrhea along with some nausea. Could this be a possible side effect from trying to reduce?

    1. Hello John, I hope you’ve found relief from your symptoms. Gas, diarrhea, and nausea are all common side effects of PPI use. Though I have not read any studies that have mentioned an increase in these while tapering off PPIs, it is possible. The lack of stomach acid due to PPI use can allow harmful bacteria to grow in the intestines. The return of normal acid levels can kill off bad bacteria. Gas, diarrhea, and nausea are also side effects experienced when this bad bacteria dies off. Following the 5Rs of functional medicine (mentioned in the article): remove, replace, repopulate, repair and rebalance may help in the reduction of these symptoms. Be sure to see your doctor about all concerns during the process of tapering off PPIs. The return of acid to your digestive tract can cause many changes. One of the ones I find most concerning is the change in absorption of medications. If you take other medications, the source of your problem could be from an increase in absorption of these medications. Best wishes!

  14. Great article. I’ve been on PPIs for 2 years (20 mg Nexium) and want to get off of it. My doctor said I should stop the Nexium cold and go to 150 mg ranitidine twice a day for 2 weeks, then once a day. After reading the other comments where people are alternating and tapering their dosage – I’m wondering if the advice I got is too much too soon? If I go the taper route, I wanted to make sure it really is ok to cut an enteric coated Nexium tablet in half (Instructions say do not crush or chew). Thanks!

    1. Hello Bob. Thank you for reading. Some people use ranitidine instead of tapering when stopping PPIs. If the acid rebound is too rough, you can always back up and taper off Nexium before switching to ranitidine. Your doctor and/or pharmacist can provide the necessary dosages of Nexium if you’re plan is to taper off your PPI. Nexium delayed-release oral suspension is available in 2.5-mg, 5-mg, 10-mg, 20-mg and 40-mg single-dose packets. Or a generic form of esomeprazole may be available at your pharmacy. Hope this helps. Wishing you the best!

  15. Wow. Been on Tecta 40mg 1/day for almost 5yrs now. Started getting hip pain and decided to research. I am definitely going to try to get off these! I had h-pylori and then found out I have a hiatal hernia. Took antibiotics for h-pylori. Having the hernia, will this be a problem dropping down eventually to just taking a Zantac or similar H2 type medication?

    1. Hello Ryan, that is a question better answered by a gastroenterologist who has first-hand knowledge of your hiatal hernia and overall health. Acid reflux occurs more easily when a hiatal hernia is involved. If needed, surgery can correct a hiatal hernia and may be warranted if the hernia is of significant size. For others, diet and lifestyle changes along with the occasional H2 blocker or antacid are adequate for controlling acid reflux symptoms due to a hiatal hernia.

  16. I’m the same Joanna that posted regarding whether I should start Betaine HCL before or after tapering off PPIs. I’m also wondering if I should start an H2 blocker, but I am hesitant until I’m down to 20 mg esomoprazole.

    I wanted to mention that I have tried DGL licorice, mastic gum, mankuna honey, aloe vera juice, dietary changes, wedge pillow, not eating before bed.

    My main symptom from tapering from 40 mg to 30 mg esomprazole is a dull ache between the shoulder blades. According to the internets, the ache is in my esophagus. I keep persevering with my tapering off the PPIs, because I really want off those drugs.

    Thank you!

  17. I am in the process of tapering off PPIs and it’s difficult. I have been at 40 mg esomprazole for almost a year and am currently on 30 mg. The plan is to go down by 10 mg every month.

    Should I start taking Betaine HCL while I’m tapering or wait until I’m completely off the PPIs? Thank you!!

    1. Hello Joanna, Betaine HCL can help with digestion and trigger the LES to close thus preventing acid reflux. If you have a low protein diet, it may not be needed. When starting Betaine HCL, it would be recommended that you’re under a physician’s care and start off with a low dosage. Consult with your doctor about Betaine HCL and the H2 blocker (mentioned in your other post) before use. Many doctors advocate the use of H2 blockers when getting off PPIs like esomeprazole. Others prefer their patients wean off without. I used H2 blockers when I weaned off my PPI. I would suggest continuing the regimen of DGL licorice, mastic gum, manuka honey, aloe vera juice, dietary changes, wedge pillow, and not eating before bed. Whatever you find that works for you in the tapering-off process and also to prevent acid reflux in the future. I wish there was a simple fix-all that would work for everyone, but we’re all different and have to keep at it till we find what works. I’ve found that home fermented ginger works well for relieving my occasional acid reflux symptoms. It sure burns going down, but within 5 to 15 minutes I feel relief. Hope you feel relief soon, Joanna! Write back anytime! Best!

  18. Hello Steve,

    I am trying to wean myself off PPI’s after 4 years or so. I was never on a higher dose than 20mg, and I’m cutting pills for over 2 months now (I’m around 10mg or less). My main symptom has always been the “air trapped” feeling or pressure. Does getting to a lower dose like 5-10mg stimulate more acid secretion/production already? I am hoping it does. I did learn about rebound reflux when I tried quitting Cold Turkey back in November. That was a hard reality. My main symptom was upset stomach. I’m wondering if I’m ready to try every other day using Zantac in between since I’m managing on a very low dose. I was diagnosed with GERD and had a very small hiatal hernia (1 cm). I just feel so desperate to get rid of these drugs since I’ve seen some deficiencies. Thoughts?

    1. Hello Matt, great to hear of your progress in getting off PPIs. If you and your doctor think you’re ready to reduce your PPI intake to every other day with Zantac in between, give it a shot. Antacids may also help. If your heartburn symptoms are more than you can handle, back up and stay on the PPI at an even smaller dose or try adding DGL, aloe vera, slippery elm, or marshmallow root to coat and protect the esophagus. If you’re having problems with gas, try increasing probiotics to see if additional good bacteria will help. A lack of healthy intestinal bacteria can cause issues with gas. Best of health!

      1. Hey Matt haven’t you considered Nissen fonduplication to treat the hernia, I have seen a lot of people benefiting from it.

        1. Hi Greg, I’ve read about that process. Mine is very small so I’m not sure if that would be for me or not. Another Family Member has a larger HH & his Doctor told him to lose more weight before they attempt surgery. Thanks for chiming in.

      2. Thank you for the reply, Steve. I actually was down to about 5mg for several weeks then I stopped altogether. It’s been over a week now. I have some episodes but nothing that feels too extreme. It’s mainly that lump/trapped air feeling. I take Zantac periodically or overnight. I use Digestive Enzymes & I’ve always used Probiotics. Lately I’ve been using Kefir which is a great way to do it with a liquid vs. a capsule. I’m curious now how long it might take to stablize given what I’m seeing now.

        1. Hello Matt, congratulations on stopping PPI use! I wish I could give you a timeline on when things might stabilize. It’s different for different people.

          1. Hello Steve, it is now 4 weeks that I am off Omeprazole. I haven’t made too many modifications & I’ve seemed to manage with Zantac & Antacids. I’m so hopeful I might start to see signs of the clear. I never deal with vomiting or other excess problems, but it hasn’t been a fun time for sure. I didn’t make many diet changes, but I have used DGL to help with some spots & my GI Doc prescribed Carafate awhile back. I also had a Vitamin D deficiency which I fixed using supplements in a few months. I really hope there is light at the end of this tunnel. Thank you for being responsive & sharing your thoughts also.

          2. Hello Matt! You’re welcome! Thanks for the update on your progress. I’m glad you’ve been able to get off Omeprazole. Sounds like you’re improving and for that I’m grateful. I’m always happy to help where I can. Hang in there, my friend! There is light at the end of the tunnel. 🙂

  19. Hi, I have been taking omeperazole daily for probably 15 years (I’m now 37) I’ve read a lot of things today about it that are really concerning me and I’m committed to getting off it. I just want to ask if useage is stopped over time do the potential increased mortality rates that may occur from taking this medicine for so long decrease? Will the effects reverse? This is really concerning me. Thanks.

    1. Hello Scott, I’ve not seen any published studies that would specifically address your concerns. You should consult a physician about any health concerns you may have. Health risks from PPI use do increase with the length of exposure. Some people need PPIs. For others, it is important to limit PPI use to instances and durations where it is medically indicated.

      1. Thanks for replying. My doctor says that the dangers of taking these cease after stopping so that’s reassuring. Also told me many people are coming in to come off omeperazole. I’ve gone 10 days now and the reflux is pretty bad especially when I drink wine. She prescribed ranitidine which apparently doesn’t have the same dire health consequences?

        1. Hello Scott, great hearing from you again! Congratulations on the 10-day mark of coming off omeprazole!… Many people have to stop drinking to control reflux symptoms, especially when getting off PPIs. Alcohol causes the lower esophageal sphincter to relax allowing acid to reflux into the esophagus… Ranitidine doesn’t have the negative side effects that PPIs have. It’s a much safer heartburn medicine. Best of luck coming off omeprazole! Stay in touch!

  20. I am 30 M, taking Rabeprazole 20mg daily for the past two months.

    I’m active and train at a Boxing Gym regularly. Since I have started taking the medication, I have been eating a very healthy diet, fresh vegetables, greens, lean fish, eggs, nuts, avocado etc. No Alcohol, Caffeine, or Smoking. Regular relaxation and meditation.

    I have been getting many odd changes in my body. I get constant nerve twitching in my legs and muscles. I’ve also been finding my body gets injured very easily from exercise. I would normally train many times a week without issue, but I have limited my workouts, and still find difficulty recovering.

    I have suspected that my body is somehow deficient in minerals and vitamins. I’ve been taking Magnesium, Vitamin B, Multivitamin Supplement. Along with a diet rich in nutritious food, and regular exercise, by now I’d normally have been in top shape.

    Is this something that would happen with this medication. I’ve read it can leech nutrients from your body, but I’m young and eat well so it feels unlikely. Is there some way to test myself.

    1. Hello Mike, your diet and exercise regimen sound great but PPIs like Rabeprazole reduce stomach acid which can cause vitamin and mineral deficiencies for people at any age. The lack of stomach acid reduces the body’s ability to absorb vitamins and nutrients, reduces the ability to synthesize certain digestive enzymes, and inhibits the breakdown of proteins into amino acids. Doctors can test for vitamin deficiencies through blood tests. If you suspect a problem, you should speak with your doctor. Best!

  21. Close to 20 years ago my GP put me on 40 mg Omeprazole which i took every day. It was great as I could eat about anything. I had a bleeding diarrhea attack 4 years ago. After a colonoscopy I was diagnosed with colitis caused by constipation and dehydration. Even though I drank a lot of water I was still having digestive problems. After an Endoscopy that showed signs of acid reflux, my Gastro doctor put me on 40 mg of pantoprazole. Two years later I had a serious stomach problem. After another Endoscopy, he put me on two pantoprazole per day. It seemed to help initially but I still had problems. I then used your article to wean off of the PPI. After a month I was off the PPI, It has been 47 days without the PPI. Occasionally I use antacid. I take a prebiotic and Betaine HCl at each meal. Once per day I take a 40 mg Chelated Magnesium Glycinate. First thing in the morning and again before bed I take RealAloe Gel.
    I also take various digestive supplements along with vitamin D and B12. I have also changed my eating habits. I eat less, eat slower, and chew my food. My concern now is that the long usage of PPI has affected my kidney and maybe my liver. I have some degree of burning when initiating urination. Also my bone density is low.
    I will see my doctor in a week from now and go over all of this with him. If there is anything you can comment on, do so. Thanks for the great information you have provided. By the way, I am 71 years old and play about 100 rounds of golf every year.

    1. Hello Chuck, thank you for sharing your experience! Sounds like you’ve been through a lot and may now be on a better path to healing. Do please see your doctor and review all you’re taking. Your doctor will be able to tell you if these natural treatments are working to meet your gastrointestinal health goals.

  22. Hi Steve, wanted to ask you about peppermint antacids won’t they affect the les. And also about using melatonin to increase the tone of the les while weaning off ppi?

    1. Hello George, peppermint can relax the lower esophageal sphincter (LES) and increase GERD symptoms. If the peppermint antacid has true mint, it would be better to take a different antacid. I’m not sure what the different companies use as flavoring, natural or artificial. I personally avoid anything mint flavored when taking antacids or otherwise relieving heartburn.

      With regard to melatonin and GERD, some smaller studies have shown melatonin to improve the tone of the LES and reduce GERD symptoms (see 2010 Study: The Potential Therapeutic Effect of Melatonin in Gastro-Esophageal Reflux Disease). The study also showed that using melatonin accelerates healing when taking omeprazole thus reducing the timeframe needed for treatment. As the melatonin and GERD studies were small, further study needs to be done. The long-term safety of melatonin also is a concern and should be studied as well.

      Thanks for the great questions! Best!

  23. Hey, Steve I have a burning question. I am on ppi (20 mg a day) for 4 months perscribed by GP because of heartburn (one to two times every two weeks). I am concened that her desicion was too drastic. So I went and had an upper gastroscopy which showed no damage on the oesophagus. So I was thinking how is GERD diagnosed and by putting someone on ppi which causes the LES to open aren’t you causing this person GERD and thus compromising any furher examinations like barium swallow test?
    Best wishes!

    1. Hello Niya, burning question indeed. GERD is generally diagnosed as having acid reflux 2 or more times a week. Many doctors will place patients experiencing chronic heartburn on PPIs without further tests or addressing the underlying problem which typically stems from diet and lifestyle concerns. I could not say but if there is no damage to your oesophagus, diet and lifestyle changes may be the answer to your GERD issues over the long-term. PPIs should take care of your GERD symptoms over the 4 month period your doctor has you on the drug. Remember PPIs do not cure GERD. PPIs mask GERD symptoms by reducing acid production. If you do not agree with your doctor’s decision, a second doctor’s opinion may be warranted.

      PPIs block acid production which can cause the LES to remain open. The LES is prompted to stay closed during the digestion process by appropriate acid levels. If the LES remains open when on PPIs, GERD symptoms can occur. Heartburn may not occur though non-acidic reflux may. PPIs are needed by some patients. Many of these patients can get off PPIs after healing from their underlining health issue.

      When on PPIs, the stomach will gradually compensate for the lower stomach acid by increasing production. This will cause a need for a higher dose of PPI to prevent acid production. If the dose is not increased, GERD symptoms may return. This is what causes the acid rebound symptoms people incur when getting off PPIs. Hopefully, you will not experience acid rebound. If you experience this side effect when getting off PPIs, you may want to follow the steps detailed in the article to prevent acid rebound.

      The barium swallow test would so how well the LES is working with or without PPIs. Some doctors will want PPIs stopped prior to testing.

      Do your best to improve your diet and make any lifestyle changes needed while on the PPIs. Taking these steps will help prevent GERD symptoms in the future. Thanks for the great questions! Taking control of your health like you’re doing is the right thing. Wishing you the best of health and happiness!

  24. Hey Steve, Dan here. Currently on 20 mg of esomeprazole daily, reduced it from 40 mg no apparent heartburn so far. I’m about to reduce it to every other day. Found Aboca NeoBianacid Acidity and Reflux and wanted to share it with you. It is both antacid (CaCo3) and mucilage (contains aloe vera, DGL, slippery elm, mastic gum, and marshmallow root). I will try to wean off with it as well as Gaviscon as I find it to be more effective when the heartburn becomes severe. Will write back again, thanks for all the information.

    1. Hello Dan! Great hearing from you and for sharing your progress and the information about the NeoBianacid Acidity and Reflux. Looks like a great product. I treat my heartburn with same ingredients. Very helpful to find them all in one tablet. I’ll have to give it a try. I look forward to hearing from you again. Best and Happy New Year!

  25. It took me six months to fully wean myself off omeprazole, after taking it for several years and at one point taking 60 mg every day. The omeprazole was masking an irritable esophagus, which I am still treating with liquid Carafate, but at least I’m off the drug associated in so many studies with kidney disease.

    Each time I decreased my dose of omeprazole I had severe esophageal pain which gradually diminished over time, which tells me that the omeprazole itself was contributing to the sensitivity in my esophagus. I wonder if this has been observed by others or has an explanation?

    1. Hello Dan, hypersecretion of stomach acid can occur when discontinuing of PPIs. It’s likely you were experiencing this rebound in acid with each decrease in omeprazole. Congratulations on getting off omeprazole! It’s a major accomplishment! Best of health!

  26. Hi Steve, It’s Adrian got off Nexium 10 days ago, had minor heartburn all was good, but awful problem with swallowing, got panicked and started Nexium again. It turns out it was tonsil stones causing the problem, do you know whether dry mouth (Nexium side effect) could have caused the tonsil stones. I hate those PPIs I can’t stand them and yet I am taking them. P.S. H2 blockers seemed not to help with heartburn although I take them with 8 oz glass of water. Once I am off the meds I will start a petition against PPIs being prescribed without upper gastroscopy. This experience is hell.. Lost 20 pounds being on them..

    1. Hello Adrian! Great hearing from you again. Hate to hear you had swallowing problems. Dry mouth is a side effect of Nexium and dry mouth does contribute to the formation of tonsil stones, so the Nexium could have been a contributing factor in the development of the tonsil stones… You might ask your doctor about taking an antacid like Tums along with the H2 blocker. Natural remedies like DGL (deglycyrrhizinated licorice) may be of help too. I took DGL daily when I weaned off PPIs.

    1. Hello Jon, PPIs are better at inhibiting gastric acid secretion than H2 blockers and are therefore associated with higher gastrin levels. PPIs directly block the proton pump inhibiting hydrogen ion exchange and the secretion in response to all stimulatory agents. H2 blockers block only histamine, thus H2 blockers leave gastrin and acetylcholine as potential stimulatory agents.

      This study on hypergastrinemia might be of further help.

  27. For about 8 years, I took 20 mg omeprazole in the a.m. which controlled my symptoms. My doctor agreed I should taper off, but she didn’t expect as much rebound as I have been experiencing. I started tapering six weeks ago. I am currently taking 20 mg only 3x a week, and 4x a week I take 10 mg.
    On the days I take only 10 mg I also take ranitidine 2x a day.
    I have found that I need to take 3/4 Tums a day to control symptoms, which are more severe than the ones that prompted my doctor to prescribe the omeprazole in the first place 8 years ago.
    Your article is the best I have found on tapering off. Do you think it is OK that I am still having symptoms and taking Tums for them, as often as 4x a day? Would it be better to take the ranitidine also on the days I take 20 mg of omeprazole?
    I understand that you don’t want to supplant my doctor’s advice, but she thought this would be a 2 week process and I’m the one who found that there is a 10 mg dose of omeprazole and got her to prescribe that. I am basically figuring out what works for me with both of us agreeing I should taper off omeprazole.

    1. Hello Kathy, I hate to hear that you’re experiencing acid rebound from omeprazole. It’s a terrible side effect. Unfortunately, I can’t advise you on the medications. The Tums are short-lived and will usually last less than 2 hours. As far as the ranitidine goes, it’s not uncommon for doctors to prescribe them when tapering off PPIs. Everyone’s conditions are different. You should ask your doctor.

      DGL (deglycyrrhizinated licorice) may be of help. DGL protects against acid by building up the mucosal membrane of the stomach and esophagus. Slippery elm and marshmallow root can also help coat and protect as well. I personally used ranitidine, Tums, and DGL when I weaned off PPIs. I found diet changes, no alcohol, and smaller meals were necessary for me, not only during the tapering off process but permanently for preventing GERD from recurring. Hope you find relief soon!

  28. Steve, for folks reading here – – I took a PPI for 10 years – – took around 4 months weaning off as slowly as I could. Wow, I’m off but didn’t know what to do next. I bought an H2 blocker and only took it when I needed it. My stomach was kind of “iffy” for about a week. Realized I had to get myself on the BRAT (banana, rice, apple, toast) diet until I felt a little balanced. Take a short walk each day before meals. I purchased fresh raw fermented sauerkraut. Never had it before – – I love it. Put it on everything from breakfast to dinner to get some probiotics in my gut. Also, just picked up some unsweetened Greek yogurt. One is no-fat the other low-fat, plan to mix them up so I can tolerate it. Going to have that for a snack with some nuts on top. I’ve been heartburn free for 3 days. My bed is raised and I stuff a bunch of pillows around me before I fall asleep so I don’t slide down flat. This is a whole lot of work but I’m off the PPI!! Please don’t stop sharing your good information. People out there are suffering – – our doctors don’t seem to get it – – what’s up with that?

    1. Thank you for sharing, Char! You are an inspiration! Thrilled that you’ve been able to wean off PPIs! It is hard work and you did it! Keep striving for digestive health. The diet and lifestyle changes are far better than being on PPIs. Best of health!

    1. Hello Mary, acid rebound after discontinuation of PPIs will differ among individuals. Hypersecretion of stomach acid is most likely when there’s a sudden discontinuation of PPI medication. For having taken Prevacid only a month, you may not experience a noticeable rebound in acid when you wean off Prevacid. Wishing you the best!

  29. Hi Steve, I was never diagnosed with gerd and still made to take nexium. I had upper GS done and nothing was found. All in all I am taking nexium without the need of it, tried stopping it once, endured 25 days and failled. I am ten days in on taking nexium, five days 40 mg, 5 days 20mg and now planning to start taking them every other day. Bought an h2 blocker and some antacids just in case things start to get hard. The first time i stopped cold turkey and didn’t like it, now i hope the rebound lasts less. Wish me luck!

    1. Hello Adrian! Thank you for sharing your experience. The acid rebound when weaning off PPIs can be rough. I know, however, that you can get off Nexium! The H2 blocker and antacids you bought will help. If you experience any problems, see your doctor. Best of luck! Keep in touch and let me know how it’s going.

  30. i have been on omeprazole 20mg daily up to 40 when needed for over 20yrs and have now been told that i need to come off it because of hip and wrist fractures i dont want to go on ranitidine as it has bad side effects concerning your heart can i come off omeprazole and just have gavison i have been told it is my nerves that are not working so pushes the food back up i have alot of heartburn

    1. Gavison has short-term benefits and may control your heartburn up to 2 hours. I’m not sure what concerns you have about your heart when using ranitidine. Please review the side effects of ranitidine and speak with your doctor. Your doctor should be able to answer your concerns about your heart and any nerve impairment that might be preventing your lower esophageal sphincter (LES) from closing properly.

  31. Hi Steve ,
    This is a great article and im sure it will help me to wean off PPI’s. I have gradually reduced my tablets and am now on 20mg every other day. (I was on 20mg every day and have taken them for 10 years). I want to start taking probiotics but what type of probiotic is best for the treatment of reflux? What type of diet would you suggest is best or is it just a case of unprocessed and low sugar / fat? They say to cut caffeine out… can you have the decafe alternative or should you just cut out tea & coffee altogether?

    Thanks in advance! I have joined mailing list for more tips!

    1. Hello Charlotte,

      Thank you! I hope the article and website will provide you the help you’ll need to wean off PPIs. I’ll try to briefly answer your questions and will provide links to articles that will go into greater depth.

      The best probiotics would be those you can easily make at home. “Probiotics for Heartburn Relief” covers the benefits of probiotics in reducing the instance of heartburn. And “Lacto-Fermented Foods and Beverages Treat Heartburn” will touch on different types of probiotic foods that are available. You might want to try making some of them yourself. I’ve found sauerkraut and yogurt to be a good place to start if you’ve never made your own.

      Diet gets more difficult to answer. Foods affect people differently. Strictly speaking, yes, unprocessed food and a low sugar diet are most important. Good fats like those from nuts, avocado, and coconut oil may be of benefit. Avoid the heartburn trigger foods. Keeping a heartburn journal will help you determine what foods give you problems and at what time of day and under what conditions.

      If you can cut out coffee and tea, you are better than me. I couldn’t cut out coffee. Eliminating sources of caffeine is best. Decaf is second best. If you count on the morning cup of coffee to keep you going, low acid coffee helps reduce acid reflux. I chose the low acid coffee option when I weaned off PPIs. It worked for me, though many have to cut out coffee entirely. If you like herbal teas, there are teas that naturally treat heartburn symptoms.

      Stay in touch! I’m happy to help where I can. Always seek the advice of your doctor when making changes to your medication and talk with your doctor about diet too.

      Best of health!

  32. Hello Steve, i recently start troubling with GERD! visited many a sites, i must say ur one is among top sites i have go through up to now. thanks for this comprehensive article on the subject. Though, i have already on “improve your life style” path, this article augments my knowledge and commitment to further improve my life style, to save me from this nasty condition again, without or less frequent medication routine. Thank you!!!

    1. Hello Furqan, you are quite welcome. Thank you for your kind words! GERD detracts from quality of life. I’m pleased that you’re on a path of improvement and wish you greatly improved health and a prosperous future! I will continue to write articles that I hope will be of help. Please check back or sign up for the newsletter. Stay in touch! 🙂

  33. I’ve developed reflux esophagitis 2 months following surgery and viral meningitis where the hospital gave me ibuprofen and antibiotics . ( Not overweight, don’t smoke, eat vegan so aside from the odd tipple not really high on lifestyle risk factors for GERD) I’ve been on PPIs lansaprazole 3 weeks and have reduced to 15mg in the morning. Recently I developed a new abdominal pain when I don’t have heartburn. How long can you take a PPI for before it causes SIBO or other gastric issues? Should I come off it if this has happened? My GP seems unconvinced of a connection but I worry the pills are making me worse. Thanks

    1. Hello, Kristy! Always follow the advice of your doctor, pharmacist, and the directions on your medication. Your doctor should know your situation best… Antibiotics destroy both good and bad bacteria in the digestive tract without the proper balance of bacteria GERD, SIBO and other digestive issues can occur. NSAIDs like ibuprofen can also cause stomach irritation and heartburn… PPIs are great for blocking acid and allowing irritated esophageal tissue to heal. You can work to rebalance bacteria in your digestive tract while still being on PPIs. You might be interested in the articles on SIBO and heartburn and on probiotics for heartburn… Concerning your question about how long one can be on PPIs before developing SIBO or other gastric issues, well, there’s no specific timeframe. Everyone is different. You might talk with your doctor to see how long you will be on PPIs and if an H2 blocker might be used for symptoms instead. Hope you find relief from the abdominal pain soon. Well wishes!

  34. Hi Mr.Steve Hood ,could u pls give me some suggestions regarding my health condition ? I am suffering from small hiatus hernia n gerd since last 5 months .,recently i have been feeling like nausea as I have stopped taking any medication ? Thanks.

    1. Hello! I’m sorry you’re suffering. Nausea is a side effect of acid reflux. You might look at the Mediterranean diet and drinking alkaline water. It’s has been proven to be as effective at treating acid reflux as PPIs. There are many other helpful articles on the website that may be of help. Please speak with your doctor to see if diet changes or if other remedies may be appropriate in your situation.

  35. Hi I have been taking rabeprazole for about 18 months. My nurse practitioner told me to stop taking them. So I stopped cold turkey. I am now having severe heartburn two hours after I eat. It lasts for quite a long time. I try gaviscon but it doesn’t help. My granddaughter told me to take Apple Cider vinegar and double my probiotic. It’s been over a week and I don’t see much improvement from taking the vinegar and twice the amount of probiotic. I really don’t want to start the drug again and have to wean myself off of it. Is there an alternative or do I have to start taking the rabeprazole again and slowly wean myself off of it?

    1. Hello Sharron,

      H2 blockers can be of help when getting off PPIs. Have you tried them in addition to Gaviscon? Ask your nurse practitioner about taking them to relieve your acid reflux symptoms. They will greatly reduce stomach acid and don’t have the side effects of PPIs like rabeprazole. “3 Levels of OTC Heartburn Medications” has a list of popular H2 blockers.

      I know the acid rebound from getting off rabeprazole has you in great discomfort. I hope you feel better soon!

      Best wishes!

  36. I have been on 30mg twice a day of several different PPI’s for over 5 years. I am 115 lbs, 4 11″ petite 38 year old women. I’m struggling to get off these things! Every time I try I get horrible sore throats or where I have a strange feeling in my throat like it’s closing or a ball in my throat (horrible feeling). I’ve had so many test and everything looks normal (thank GOD). I just got diagnosed with SIBO which can be caused by heavy doses of PPI’s and now finishing up an antibiotic. I feel like this drug has made my situation worse and if 5 years ago I just took it for a few weeks, as it’s attended to be taken. I would never be in this situation. The FDA has stated not to take PPI’s longer then a few weeks. I wish my doctor would have told me that I would of never continued this long. Right now I’m just trying to wean down by taking 30mg in the morning and then take 15mg at night and I already have a sore throat. It’s completely hopeless, I feel like I will have to stay on these things for the rest of my life.

    1. Hello Samantha,

      It can be difficult to get off PPIs but you can do it!

      Heartburn is worse at night. Speak with your doctor about reversing the times you’re taking the PPI to take 15mg in the morning and 30mg at night. Taking an H2 blocker and/or antacids can help when heartburn gets bad.

      When on PPIs for a long time intestinal flora may be out of balance. Antibiotics also kill off good bacteria in your digestive tract. Probiotics can prevent heartburn by balancing healthy and unhealthy bacteria in the digestive tract to reduce the instance of acid reflux.

      The closing or a ball in your throat could be dysphagia, a condition that can be caused by chronic heartburn.

      Hang in there!

  37. Hello! I’ve been trying to reduce Zantac from 450mg a day to half of the dosage. Could I cut Zantac in half? Does it change its action in the body? Excellent article, thank you.

    1. Thank you, Cristiane! You will need to talk with your doctor and pharmacist. Controlled release medications should not be cut in half. Lowering dosages of medications that aren’t controlled release is common practice though dosages may vary when you divide them. Buying lower dosages may be the better route if you have trouble regulating the dose when dividing the medication.

  38. Hi, I am taking pantoprazole since 2 years ago but before then I was taking omeprazole for about 2yrs as well. I know it’s both under PPI but for me, Pantoprozole works more effective. But since I read about the worst side effect of the PPI for a long period of time used I am so concerned that I might be one of 25% who will have a short life expectancy. So I made a research myself and I found out that there is this DGL Licorice with the same purpose. although I haven’t read any negative side effect sofar regarding this med. Could some one tell me if this has the same side effect with PPI?

    1. Hello Toto,

      Deglycyrrhizinated licorice (DGL) is a dietary supplement used to provide relief from heartburn, indigestion, stomach ulcers, and more. It is not a PPI and does not lower stomach acid production. Nor does it have the same side effects of PPIs.

      The use of DGL as a heartburn remedy is different from PPIs. DGL is a form of mucilage that coats and protects the digestive lining to help prevent acid irritation. Licorice in deglycyrrhizinated form, DGL, is generally considered safe and should always be used when taking licorice to avoid the potential side effects of glycyrrhizin.

      Glycyrrhizic acid or glycyrrhizin is a substance in natural licorice that can cause symptoms of hypertension and edema. For those who are pregnant glycyrrhizin causes shorter gestation periods, miscarriage, low birth weight, and allows cortisol to penetrate the placenta impairing brain development in the fetus. Deglycyrrhizinated means that the glycyrrhizin has been removed to avoid these symptoms.

      Do not make changes in medication or take any medication or supplement without first consulting a doctor.

      Hope I was able to make some clarifications for you. Best wishes!

  39. I’ve been on 20 mg/day Omep for over 10 years. Just once in the AM. it seems to take care of my heartburn, but I’d like to get off them if I could. My doctor says I’m fine forever at my dose but has also said if I want to try to get off them, go off slow just like you’ve said. My question is about the dose. Is 20/day nothing to worry about? My weight is good, overall health is good with a few issues that 60+ men get, but the long term nature of the drug concerns me.

    1. Hello Jim. Thanks for getting in touch! Removing the use of any drug that isn’t needed is usually the wise choice. Trust in your doctor’s advice. Your doctor knows you and your individual situation. If your doctor is onboard with tapering off omeprazole, it may benefit you to see how you do without the PPI. If you taper off omeprazole and future symptoms aren’t adequately controlled by use of H2 blocker and/or antacid, you can always go back on omeprazole.

  40. What a life-saver finding your website. I have been taking 2 x 20 mg Omeprazole in the morning and 2 x 150 mg Ranitidine in the evening for the last 6 months. I have significantly changed my diet, lost weight, upped my exercise and now feel confident that I can start the process of cutting back on these medications. I will follow your recommendations for doing so.

    1. Hello Mary! Thank you! Congratulations! You’ve made a great amount of progress! Much of the hard work is behind you now. Making those changes in diet and exercise to lose weight are a challenge. Be sure to cut back on the Omeprazole first. Ranitidine will help in your success and doesn’t have the same harmful side effects as a PPI. Wishing you the best! Keep us informed of your progress.

    2. Mary, Take your time reducing your dosage. As the article says…it is different for each person. Be patient.

  41. I’ve been taking 3 omeprazole a day (20 mg/dose) for 10 years. I tried cutting back to 2 a day about two years ago, but I ended up with a severely irritated esophagus and had to go back to 3. After cycling through several gastroenterologists since then (they all told me that omeprazole is safe and to just live with it), I finally found one helping me to cut back with the help of liquid Carafate, an ulcer medication. I feel much healthier just cutting back to 2 omeprazole a day, and I know I will feel even better on 1 a day.

    1. That’s wonderful news, Dan! Thrilled you’ve found a gastroenterologist that’s helping you wean off PPIs and that you’re feeling better! Thank you for sharing your experience. Cutting back on omeprazole can be a challenge and you’re succeeding! Keep us informed of your progress. Your progress is inspiring!

  42. Good article but I am on PPI daily once in morning since last 3 years.. since I detected with symptoms of blotting heaviness restlessness and in easiness which ease out once I burp from mouth..

    I am not able to get rid of PPI.. trying since last 1 and half year and facing stomach upset issue frequently

  43. It helped me wean off the Protonix while gradually cutting the days I took the PPIs. BTW, my Internist first prescribed Prilosec, which was worse on my gut than the IBS I was also experiencing at that time.

  44. Hi! im Saud Kadir 17 years old from philippines
    i was diagnosed with what you call GERD and my medications are too much i have been given a Domperadon 3xday(30pcs),Augmentine 3xday(30pcs), nexium 2xday (20) pcs
    and Gel-malicid 3xday (10pcs). i have to drink it in ten day and also i have given a vitamins cause that doctor said that i am Underweight or skinny and give me Vitamin(m) and ascorbic acid… i need to drink it for 10 days.. is it okay

    1. Hello Saud Kadir! Thank you for reading and your question. I too had GERD at a young age and wish you the best on your road to recovery. There are many different treatment options for GERD. Lifestyle and diet changes (see those in this post) are typically required to eliminate GERD. Medications are necessary at times in the treatment process. Your doctor knows your medical conditions and is the best person to consult conserning treatment. How To Treat Heartburn has many articles that may help you better understand your condition. Please discuss the treatment options in the posts to determine with options might be of benefit in your situation. Best! ~ Steve

  45. on rabotide 20mg X 1 daily for about 2 months..what are the best way to wean off by the way i was diagnosed with ulcer and gastritis..thanks

    1. It’s important to discuss weaning off your PPI with your doctor. You will need to make sure the timing is proper with the treatment of your ulcer and gastritis. This article outlines the steps for weaning off PPIs like Rabotide/Aciphex (Rabeprazole Sodium). Please discuss the steps with your doctor to determine the best plan of action for your situation. Wishing you the best in your healing process!

  46. Wow! My doctor said not to worry about the side effects….Very scary as I am on a permanent daily prescription. Thanks for the info!

    1. Hello Rod! Some people with certain conditions do have to be on them long term, but PPIs do have bad side effects. If your condition can be managed by use of other treatments and lifestyle changes, research shows it best to avoid PPIs. When possible, always get a second doctor’s opinion. Discuss your concerns and treatment options with your doctor. Best!

      1. One of the best Article I ever read since I have been diagnosed to have Gastritis and lax lower esophageal sphincter.
        I was suffering from intermittent acidity and heart burns since last 20 years which can be managed by intermittent ppi ( as H2 blocker are not so quick enough) .
        From last year had intermittent chest pain at rest for which I undergone detail cardiac evaluation which was normal. Lastly cardiologist asked me to do gastroscopy were they found lax lower esophageal sphincter and mild Gastritis. Gastroenterologist put me on ppi twice a day and after that I could not able to wean from medicine. Now from last six months I am on ppi.
        Your article is very encouraging for me.
        Started lifestyle changes, diet changes, light exercise and will start tapering ppi.
        Do you have any idea about German remedy Iberogast ? I was thinking of starting Iberogast.
        Thanks again.

        1. Thank you, Santosh! Sounds like you’re on the right path. Iberogast is a great product. The only ingredient I don’t like for acid reflux issues is peppermint. Peppermint can cause the LES to relax. Peppermint does work well for an upset stomach. We all respond differently to different treatments. Iberogast is worth a try. If it doesn’t work, you might look at Deglycyrrhizinated Licorice (DGL). Well wishes! Stay in touch!

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