Continue Your Current Nexium Treatment and Resume Daily Dosing
You should continue taking your Nexium daily (not every other day) and not taper off yet, as your gastritis symptoms are recurring and you're experiencing new acid reflux symptoms. 1
Why Your Symptoms Returned
Your symptoms came back for two key reasons:
- Inadequate food intake during the flu reduced the protective effect of eating regularly, allowing acid to irritate your healing stomach lining 1
- You may have started tapering too early – NSAID-induced gastritis requires a full 8 weeks of daily PPI therapy to ensure complete healing, not just 2-3 weeks 1
The American College of Gastroenterology specifically recommends continuing esomeprazole at 40mg once daily for a full 8 weeks to ensure complete healing of NSAID-induced gastritis 1. Your current plan of tapering after only 2 weeks is premature.
What You Should Do Right Now
Immediate actions:
- Resume daily Nexium – take it every day, not every other day, for the full 8-week course 1
- Take it 30-60 minutes before breakfast for optimal effectiveness 2
- Eat regular meals even if your appetite is reduced from the flu – an empty stomach allows more acid exposure 1
- Avoid all NSAIDs completely (ibuprofen, naproxen, aspirin except baby aspirin if prescribed) as they dramatically increase your risk of complications even while on Nexium 1
Critical Next Steps
You need H. pylori testing if you haven't had it yet:
- The American College of Gastroenterology recommends testing for H. pylori infection immediately in all patients with NSAID-induced gastritis, as it increases NSAID-related complications by 2-4 fold 1
- If positive, you'll need eradication therapy (triple therapy: PPI + amoxicillin 1000mg twice daily + clarithromycin 500mg twice daily for 14 days) 1
When to Worry – Seek Immediate Care If You Develop:
- Vomiting blood (hematemesis) or coffee-ground material 1
- Black, tarry stools (melena) indicating bleeding 3
- Severe abdominal pain that's different from your usual symptoms 1
- Difficulty swallowing 1
- Significant weight loss 1
- Persistent vomiting that prevents you from keeping down food or medications 1
These alarm symptoms may indicate ulcer complications requiring urgent endoscopy 1.
After the Full 8 Weeks
Once you complete the full 8-week course and your symptoms have completely resolved:
- The American Gastroenterological Association suggests attempting a trial withdrawal of PPI therapy 1
- If symptoms recur after stopping, resume PPI therapy on-demand or continuously 1
- Many patients with GERD symptoms severe enough to warrant initial PPI therapy will require chronic treatment 4
Common Pitfall to Avoid
Don't assume your symptoms are "just from the flu" – the American Gastroenterological Association emphasizes that poor compliance with PPI therapy increases the risk of NSAID-induced adverse events 4-6 fold 1. Your recurring symptoms indicate your gastritis hasn't fully healed yet, and stopping treatment prematurely puts you at risk for ulcer development and bleeding.
Pain Relief Alternative
Use acetaminophen (Tylenol) for any pain relief needs instead of NSAIDs, as it does not cause gastric injury 1.