Continue PPI for Another Week Before Tapering
Given your recent illness and return of gastric symptoms, you should extend your full-dose PPI (40mg daily) for an additional 1-2 weeks before beginning the taper, as intercurrent illness can disrupt gastric healing and your symptoms have not yet fully stabilized. 1, 2
Rationale for Extending Treatment
Your situation involves two key factors that support continuing full-dose therapy:
Incomplete symptom resolution: While your dizziness resolved, the return of sour/bloated stomach symptoms during your recent illness indicates your gastric mucosa has not fully healed. The 2022 AGA guidelines recommend a 4-8 week trial of PPI therapy for reflux symptoms, and you've only completed 2 weeks at full dose. 1
Intercurrent illness impact: Your recent systemic illness (fever, chills, congestion) likely increased physiologic stress and inflammatory mediators that can impair gastric healing and temporarily worsen gastritis symptoms, even after NSAID discontinuation. 3
Recommended Management Plan
Extend full-dose PPI therapy:
- Continue your current PPI 40mg once daily for another 7-14 days until symptoms fully resolve for at least several consecutive days. 1, 4
- Then proceed with your planned taper: every-other-day dosing for one week before discontinuation. 2
Do NOT switch to H2-receptor antagonists at this point:
- PPIs are significantly more effective than H2-blockers for healing NSAID-induced gastric injury and controlling acid-related symptoms. 5, 4
- H2-receptor antagonists should be reserved for managing breakthrough symptoms after PPI discontinuation, not as replacement therapy during active healing. 2
Managing the Taper and Discontinuation
When you do begin tapering after symptom resolution:
Expect rebound symptoms: Transient upper GI symptoms (heartburn, bloating) may occur within the first few days of tapering due to rebound acid hypersecretion (RAHS), which is a normal physiologic response to stopping PPIs. 2
Use on-demand therapy for breakthrough symptoms: Keep H2-receptor antagonists (like famotidine) or over-the-counter antacids available to manage any transient symptoms during and after the taper, rather than immediately resuming continuous PPI therapy. 2, 6
Timeline for complete resolution: RAHS symptoms typically last 3-7 days but the underlying parietal cell hyperplasia takes 2-6 months to fully regress. If severe symptoms persist beyond 2 months after discontinuation, this suggests either a continuing need for PPI therapy or a non-acid cause requiring further evaluation. 2, 6
Comparing Your Two Treatment Courses
Your observation about your previous gastritis episode is instructive:
- Previous course: 40mg twice daily for 1 week, then once daily for 3 weeks (total 4 weeks) with slower symptom resolution
- Current course: 40mg once daily for 2 weeks with rapid initial improvement, then symptom recurrence during illness
The fact that your symptoms resolved quickly initially suggests your current gastritis may be less severe, but the illness-related recurrence indicates healing is incomplete. Extending treatment by 1-2 weeks at full dose is appropriate and still represents a shorter total course than your previous episode. 1, 4
Critical Counseling Points
Do not interpret post-taper symptoms as treatment failure:
- Experiencing upper GI symptoms after stopping or tapering PPIs does not necessarily mean you need to immediately return to continuous therapy—these often represent temporary RAHS rather than disease recurrence. 2
When to seek urgent evaluation:
- Return immediately if you develop alarm symptoms: difficulty swallowing, persistent vomiting, unintentional weight loss, evidence of GI bleeding (black tarry stools, vomiting blood), or severe persistent pain. 7
Common Pitfalls to Avoid
Don't taper too aggressively: Your planned taper (every-other-day for one week) is reasonable, but only begin it once symptoms have been completely resolved for several days. Both gradual tapering and abrupt discontinuation show similar success rates (31% vs 22% remaining off PPIs at 6 months), but starting the taper while symptomatic increases failure risk. 2, 8
Don't confuse RAHS with disease recurrence: The transient symptoms that occur after PPI discontinuation are expected and self-limited, not an indication to resume long-term therapy unless they persist beyond 2 months or are severe. 2, 6