Can gastritis caused by taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), such as Advil (ibuprofen) and Lodine (etodolac), and a history of previous gastritis, become irreversible with prolonged symptoms of sour stomach and dizziness, especially after eating, in a patient being treated with Nexium (esomeprazole) and licorice DGL (deglycyrrhizinated licorice)?

NSAID-Induced Gastritis: Reversibility and Management

Your gastritis is almost certainly reversible—NSAID-induced gastric damage heals completely in the vast majority of patients once NSAIDs are stopped and appropriate acid suppression is initiated. 1

Why You Should Not Be Worried About Irreversible Damage

• NSAID gastropathy typically causes erosions and ulcers that heal completely once the offending agent is discontinued and proton pump inhibitor (PPI) therapy is started 2, 3
• The FDA label for etodolac (Lodine) confirms that discontinuation of NSAID therapy is "usually followed by recovery to the pretreatment state" 1
• Even in patients with established NSAID-associated gastric ulcers, healing rates with esomeprazole (Nexium) are excellent, with the drug demonstrating superior efficacy in healing NSAID-associated gastric ulcers compared to other agents 4
• Permanent damage (such as gastric outlet obstruction or perforation) only occurs with severe, untreated ulcers—not from the symptoms you're describing 2

Your Current Treatment Plan is Appropriate

The combination of Nexium (esomeprazole) and stopping NSAIDs is the correct first-line approach for your situation 5, 6, 4:

• Nexium provides potent acid suppression that is essential for mucosal healing 4
• PPIs reduce the risk of bleeding ulcers in high-risk NSAID users by approximately 75-85% 6
• Your history of previous gastritis places you in a high-risk category, making PPI therapy particularly important 7, 5

Critical Next Steps

Immediately and permanently discontinue both Advil (ibuprofen) and Lodine (etodolac) 5, 6, 1:

• Patients with prior ulcer disease have a greater than 10-fold increased risk for developing GI bleeding compared to those without this history 1
• The FDA specifically warns that NSAIDs should be "prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding" 1
• Even short-term NSAID therapy carries significant risk in patients like you with previous gastritis 1

Get tested for H. pylori infection if you haven't already 7, 5, 6:

• H. pylori infection increases NSAID-related GI complications 2-4 fold 6
• If positive, eradication therapy should be added to your PPI regimen 8
• Testing is particularly important because you had gastritis previously in the summer 7

Understanding Your Symptoms

Your symptoms (sour stomach before dinner that improved with food, followed by persistent dizziness after eating) are consistent with NSAID-induced gastritis 3:

• The fact that symptoms improved with food initially is typical—food can temporarily buffer gastric acid 3
• Dizziness after eating could indicate several things: anemia from chronic low-grade bleeding, dehydration, or autonomic dysfunction related to gastric inflammation 1
• The worsening symptoms after arriving at your location may reflect cumulative NSAID damage reaching a threshold 2, 3

Duration of Treatment

• Continue Nexium at the dose your provider prescribed (typically 40mg once or twice daily) for at least 8 weeks to ensure complete healing 8, 4
• After healing is confirmed, you may be able to reduce to maintenance dosing 8
• DGL (deglycyrrhizinated licorice) has some historical evidence for duodenal ulcer healing, though the data is limited and dated 9

Important Caveats and Monitoring

Watch for alarm symptoms that require immediate medical attention 8:

• Vomiting blood (hematemesis) or coffee-ground material
• Black, tarry stools (melena) indicating GI bleeding
• Severe or worsening abdominal pain
• Persistent vomiting
• Significant unintentional weight loss

For future pain management (such as dental procedures), you must avoid traditional NSAIDs 5, 6:

• Use acetaminophen (≤4g/day) as your first-line analgesic 6
• If anti-inflammatory effects are absolutely necessary, a COX-2 selective inhibitor plus PPI is the only appropriate option for someone with your history 5, 6
• Never use traditional NSAIDs like ibuprofen or etodolac again without explicit discussion with a gastroenterologist 5, 1

The dizziness warrants specific attention:

• Have your provider check a complete blood count to rule out anemia from chronic blood loss 1
• Monitor blood pressure, as NSAIDs can cause hypertension and fluid retention 1
• Ensure adequate hydration, as gastritis can reduce oral intake 3

Bottom Line

You have not caused irreversible damage. NSAID-induced gastritis and even ulcers heal completely in the vast majority of patients with appropriate treatment 1, 2, 4. Your treatment plan with Nexium is correct, but the most critical action is permanent discontinuation of all NSAIDs 5, 6, 1. With 2.5 weeks of symptoms and appropriate treatment now initiated, you should expect significant improvement within 4-8 weeks 4.