I was diagnosed with NSAID‑induced gastritis 4 weeks ago, took esomeprazole (Nexium) 40 mg daily for 3 weeks and stopped; now I have heartburn, epigastric soreness, intense post‑prandial hunger and occasional dizziness—what management steps should I take?

Management of Recurrent Gastritis Symptoms After Stopping Esomeprazole

You should resume esomeprazole 40 mg daily immediately and continue for at least 8 weeks total (not just 3 weeks), as NSAID-induced gastritis typically requires longer treatment duration than you received. 1, 2

Why Your Symptoms Returned

Your gastritis has not fully healed—3 weeks of PPI therapy is insufficient for complete mucosal healing in NSAID-induced gastritis. 1, 2 The fact that you experienced immediate symptom relief doesn't mean the underlying inflammation resolved; esomeprazole suppresses acid quickly (within days) but mucosal healing takes 6-8 weeks. 2, 3 You stopped treatment prematurely, which is one of the most common pitfalls in gastritis management. 1

The trigger foods you ate (red sauce, which is acidic and contains tomatoes) combined with stress from your upcoming midterm likely provoked acid rebound after stopping the PPI, exposing incompletely healed gastric mucosa. 4, 5

Immediate Management Steps

Restart PPI Therapy

• Resume esomeprazole 40 mg once daily, taken 30-60 minutes before breakfast, for a full 8-week course. 1, 2, 3
• Do not taper off after 3 weeks this time—complete the full 8-week treatment regardless of symptom improvement. 2, 3
• Esomeprazole 40 mg provides superior acid control compared to other PPIs and maintains intragastric pH above 4 for longer periods. 2, 3

Dietary Modifications During Treatment

• Strictly avoid trigger foods: tomato-based sauces, citrus, chocolate, mints, carbonated beverages, and high-fat meals. 6
• Eat smaller, more frequent meals rather than large portions (your pasta dinner with multiple components was likely too much volume). 6
• Continue eating adequate breakfast—insufficient food intake worsens symptoms by triggering hunger-related acid secretion. 6

Breakthrough Symptom Management

• Use antacids (like Tums) for immediate relief of breakthrough symptoms, but these are adjunctive only—they don't heal gastritis. 1, 6
• Take antacids as needed between meals, not as a substitute for PPI therapy. 6

Why You're Not "Back to Square One"

You haven't undone all your progress—you've experienced a predictable relapse from premature PPI discontinuation, not re-injury. 7 The difference between your current symptoms (mild heartburn, soreness, hunger) and your initial presentation (severe bloating, constant pain, significant dizziness) demonstrates partial healing occurred. 7, 5

Your dizziness after eating yogurt and rice cakes this morning is likely vagal nerve stimulation from residual gastric inflammation, not a sign of complete treatment failure. 1 This symptom should resolve with resumed PPI therapy. 5

Treatment Duration and Monitoring

Complete the Full Course

• Continue esomeprazole 40 mg daily for 8 weeks total from when you restart. 2, 3
• After 8 weeks, if completely asymptomatic, you can attempt gradual tapering: reduce to 20 mg daily for 2 weeks, then stop. 1, 7
• If symptoms recur during tapering, return to 40 mg daily and consider maintenance therapy. 7

When to Seek Further Evaluation

• If symptoms don't improve within 1 week of restarting esomeprazole (85% of patients who respond at 1 week remain symptom-free at 4 weeks). 8
• If you develop alarm symptoms: vomiting blood, black tarry stools, severe unrelenting pain, difficulty swallowing, or unintentional weight loss. 9
• If symptoms persist despite 8 weeks of proper PPI therapy—this would warrant endoscopy to rule out other causes. 6

Stress Management

Your midterm stress is a real contributing factor—stress increases gastric acid secretion and delays healing. 1 However, stress alone didn't cause this relapse; premature PPI discontinuation is the primary issue. 7 Managing stress through adequate sleep, regular meals, and relaxation techniques will support healing but cannot substitute for proper medication duration. 6

Critical Pitfall to Avoid

Do not stop PPI therapy based on symptom resolution alone. 1 Symptom improvement occurs within days, but complete mucosal healing requires 6-8 weeks of continuous therapy. 2, 3 Stopping at 3 weeks because you "felt great" led directly to your current relapse. 7 This time, complete the full 8-week course regardless of how good you feel. 2, 3