What should I do about my recurring gastritis symptoms after stopping Nexium (Esomeprazole) and experiencing lingering hunger, given my history of NSAID-induced gastritis?

Management of Recurring NSAID-Induced Gastritis Symptoms After PPI Tapering

Direct Recommendation

You should resume daily Nexium (esomeprazole) 40 mg immediately and continue for at least 8 weeks total before attempting any taper, as premature discontinuation of PPI therapy in NSAID-induced gastritis commonly leads to symptom recurrence and incomplete mucosal healing. 1

Why Your Symptoms Returned

• Abrupt PPI discontinuation after only 3 weeks is insufficient for complete healing of NSAID-induced gastric injury, even though your symptoms resolved—mucosal healing lags behind symptom improvement by several weeks 1, 2

• The "lingering hunger feeling" you're experiencing is likely acid rebound hypersecretion, a well-documented phenomenon that occurs when PPIs are stopped too quickly, causing increased gastric acid production that can re-injure healing mucosa 1, 2

• PPIs must be taken consistently to work effectively—the evidence shows that poor compliance with gastroprotective therapy increases the risk of GI adverse events 4-6 fold 1, 3

Immediate Action Plan

Resume Full-Dose PPI Therapy

• Restart esomeprazole 40 mg once daily immediately and take it 30-60 minutes before your first meal of the day for optimal acid suppression 1, 2

• Continue daily therapy for a minimum of 8 weeks total (not just until symptoms resolve), as this is the standard duration needed for complete healing of NSAID-associated gastric ulcers and erosions 1, 2

• Do not skip doses during this healing phase, as PPIs only work when taken consistently 1

Avoid All NSAIDs Completely

• Absolutely avoid all NSAIDs (ibuprofen, naproxen, aspirin >81mg, etc.) during the healing phase and ideally permanently if you have recurrent NSAID-induced gastritis, as you are now in a high-risk category for serious GI complications 1, 3

• If you require pain relief, use acetaminophen (Tylenol) instead, which does not damage the gastric mucosa 1

Proper PPI Tapering Strategy (After 8 Weeks)

When to Consider Tapering

• Only attempt tapering after completing a full 8-week course of daily PPI therapy while remaining completely symptom-free for at least 2-3 weeks 1, 2

• If you have any ongoing symptoms (bloating, sourness, hunger pangs, epigastric discomfort), do not taper—continue full-dose therapy 1, 4

How to Taper Safely

• Step 1: After 8 weeks of esomeprazole 40 mg daily, reduce to esomeprazole 20 mg daily for 2 weeks 1, 2

• Step 2: If no symptoms return, switch to every-other-day dosing (20 mg) for another 2 weeks 1

• Step 3: If still symptom-free, attempt complete discontinuation 1

• If symptoms recur at any step, immediately return to the previous effective dose and maintain for another 4 weeks before attempting to taper again 1, 4

Role of DGL Licorice

• While DGL (deglycyrrhizinated licorice) may provide temporary symptomatic relief through its demulcent properties, it is not a substitute for PPI therapy and does not heal NSAID-induced gastric injury 1

• You can continue using DGL as needed for symptom relief, but it should be considered adjunctive therapy only, not primary treatment 1

Critical Warning Signs

Seek immediate medical attention if you develop any of the following 4:

• Vomiting blood or coffee-ground material
• Black, tarry, or bloody stools
• Severe or worsening abdominal pain
• Unexplained weight loss
• Difficulty or pain with swallowing
• Persistent vomiting

Why Three Weeks Was Insufficient

• Endoscopic studies show that while symptoms may resolve within 2-3 weeks, complete mucosal healing of NSAID-induced gastric erosions and ulcers requires 8-12 weeks of continuous PPI therapy 1, 2

• Your previous episode taking "about 4 weeks" was also likely insufficient for complete healing, which may explain why you developed recurrent gastritis more easily this time 3, 2

• Patients with recurrent NSAID-induced gastritis are at very high risk (approaching 10% annually) for serious GI complications including bleeding and perforation if NSAIDs are resumed or if adequate healing time is not allowed 1, 3

Long-Term Prevention Strategy

• If you absolutely must use NSAIDs in the future (which should be avoided), you will require continuous co-therapy with a PPI—this means taking esomeprazole 20-40 mg daily every single day you take NSAIDs 1, 3

• Consider testing for H. pylori infection, as eradication reduces the risk of recurrent NSAID-induced ulcers by 2-4 fold in patients who must continue NSAID therapy 1, 3

• The combination of prior gastritis history plus any future NSAID use places you in the "very high-risk" category where even protective strategies may not fully prevent complications 1, 3