Are my current symptoms of intermittent discomfort, sour taste, and swallowing issues normal for my treatment timeline, or should I increase my PPI dosage to twice a day?

Management of Persistent GERD Symptoms After H. pylori Treatment

Your symptoms at 5 weeks of PPI therapy are within the expected timeline for healing, and you should increase to twice-daily PPI dosing now rather than waiting longer. 1

Your Current Situation

You have completed H. pylori eradication (confirmed negative on two separate tests) and are now 5 weeks into PPI therapy for presumed GERD with laryngopharyngeal reflux (LPR) symptoms. Your symptoms include:

• Left-sided chest/rib discomfort
• Central chest discomfort radiating to back
• Sour taste in throat (acid reflux)
• Dysphagia sensation (funny feeling swallowing)

These symptoms suggest inadequate acid suppression on once-daily PPI therapy. 1

Immediate Action: Increase PPI Dosing

You should escalate to twice-daily PPI dosing immediately based on the following evidence:

• The American Gastroenterological Association recommends that patients with partial or no response at 4-8 weeks should increase to twice-daily PPI or switch to a more effective acid suppressive agent 1
• For suspected extraesophageal GERD syndromes (your throat symptoms and swallowing issues), twice-daily PPI therapy is specifically recommended when esophageal symptoms are also present 1
• Your timeline of 5 weeks with persistent symptoms clearly indicates inadequate response to once-daily dosing 1

Dosing instructions:

• Take one PPI dose 30-60 minutes before breakfast 1
• Take second dose 30-60 minutes before dinner 1
• Continue for another 4-8 weeks before reassessing 1

Why Your Symptoms Are "Normal" But Require Action

Your symptoms at this timeline indicate you are a non-responder to single-dose PPI therapy, which occurs in a significant proportion of GERD patients. This is not abnormal, but it does require dose escalation:

• Many patients with GERD severe enough to warrant PPI therapy will require chronic, often twice-daily dosing for adequate symptom control 1
• The presence of both esophageal symptoms (chest discomfort) and extraesophageal symptoms (throat symptoms, dysphagia sensation) suggests more severe reflux requiring higher-dose therapy 1
• Healing of presumed gastritis and esophagitis typically takes 8 weeks, and you are only at week 5 2

Timeline Expectations After Dose Increase

After increasing to twice-daily PPI:

• Reassess symptoms at 4-8 weeks (total of 9-13 weeks from initial PPI start) 1
• You should notice improvement in throat symptoms and chest discomfort within 1-2 weeks of dose escalation 2
• Complete healing may take the full 8 additional weeks 2

Alternative PPI Options

If twice-daily dosing of your current PPI remains inadequate, consider switching to:

• Esomeprazole 40 mg twice daily (more potent, less CYP2C19 metabolism) 1, 3
• Rabeprazole 20-40 mg twice daily (less CYP2C19 metabolism) 1, 3
• Dexlansoprazole once daily (extended-release formulation providing longer acid suppression) 1

Adjunctive Measures You Should Implement Now

Lifestyle modifications (critical for LPR symptoms):

• Elevate head of bed by 6-8 inches (not just pillows—entire bed frame) 1, 3
• No food within 3 hours of bedtime 1, 3
• Weight management if applicable 1, 3
• Avoid tight clothing around abdomen 1

Adjunctive medications:

• Alginate antacids (Gaviscon) for breakthrough symptoms, especially after meals 1, 3
• H2-receptor antagonist at bedtime (e.g., famotidine 20 mg) if nighttime symptoms persist, though be aware of tolerance development with prolonged use 3

What to Expect at Endoscopy

When you eventually receive endoscopy:

• If no erosive esophagitis is found, you likely have non-erosive reflux disease (NERD) or functional heartburn, which still warrants PPI therapy based on symptom control 1
• If erosive esophagitis is found, you will require long-term daily PPI maintenance therapy (not on-demand dosing) 1, 4
• The endoscopy will help determine whether you need lifelong therapy or can eventually taper 1

Critical Pitfalls to Avoid

Do not continue inadequate therapy:

• Waiting longer on once-daily dosing when symptoms persist at 5 weeks will only prolong your discomfort without benefit 1
• The decision to escalate should be based on symptom burden and quality of life impact 1

Do not stop PPI abruptly:

• If you eventually discontinue PPIs, you may experience rebound acid hypersecretion causing temporary worsening of symptoms 4
• This is physiologic and does not indicate treatment failure 4

Do not assume gastritis without confirmation:

• While post-H. pylori gastritis is possible, your symptoms are more consistent with GERD/LPR 1
• The endoscopy will clarify this when performed 1

Long-Term Considerations

After symptom control is achieved:

• You will likely require chronic PPI therapy, as spontaneous remission of GERD is uncommon 1
• Once symptoms are controlled for 8-12 weeks, attempt to taper to the lowest effective dose 1
• If you have non-erosive disease, on-demand therapy may be possible after initial healing 1, 4
• If erosive esophagitis is confirmed, daily maintenance therapy is required (less than daily dosing leads to high recurrence rates) 1, 4

Safety of long-term PPI use:

• The risks associated with stopping therapy (symptom recurrence, potential complications) generally outweigh theoretical long-term risks when PPIs are appropriately indicated 1
• No routine monitoring (bone density, B12, etc.) is recommended solely due to PPI use 1