I am an adult diagnosed with gastritis four weeks ago, treated with esomeprazole (Nexium) 40 mg daily for three weeks and tapered for two weeks; my sourness, bloating, and tenderness have resolved, but I now experience episodes of dizziness after meals—what could be causing this post‑prandial dizziness and how should I evaluate and manage it?

Post-Prandial Dizziness After PPI Tapering

Your post-meal dizziness during PPI tapering is most likely rebound acid hypersecretion (RAHS), not vagus nerve stimulation, and you should manage it with as-needed H2-receptor antagonists or antacids rather than resuming full-dose PPI therapy.

Understanding Your Symptoms

Your dizziness is occurring during a critical window when your stomach is physiologically adjusting after PPI withdrawal:

• Rebound acid hypersecretion typically emerges during PPI tapering and can persist for 2-6 months after discontinuation, as parietal cell and enterochromaffin-like cell hyperplasia takes this long to fully regress 1
• The timing of your symptoms (appearing during the 2-week taper after 3 weeks of treatment) aligns perfectly with RAHS, which commonly manifests as upper GI symptoms including post-prandial discomfort that can trigger autonomic responses like dizziness 1
• Your original gastritis has likely healed (evidenced by resolution of sourness, bloating, and tenderness), but the PPI withdrawal itself is now causing transient acid rebound 1

Recommended Management Strategy

Do not resume full-dose esomeprazole 40 mg daily. Instead, follow this approach:

Immediate symptom control (next 2-8 weeks):

• Use as-needed H2-receptor antagonists (like famotidine 20 mg) or over-the-counter antacids when you experience post-meal dizziness 1
• Alternatively, consider on-demand PPI dosing (esomeprazole 20 mg only when symptomatic, not daily) rather than continuous therapy 1, 2
• These lower-potency options provide symptom control without committing you back to continuous PPI therapy 1

Timeline expectations:

• Symptoms lasting less than 2 months after PPI withdrawal are likely RAHS and do not indicate need for continuous PPI therapy 1
• Only if severe symptoms persist beyond 2 months should you consider that your gastritis may require ongoing treatment 1
• Most patients successfully discontinue PPIs using as-needed alternatives, with 75% using H2-receptor antagonists or antacids for symptom control at 6 months 1

Critical Pitfalls to Avoid

Do not interpret short-term withdrawal symptoms as treatment failure:

• The dizziness you're experiencing does not mean your gastritis has returned—it's a predictable physiologic response to PPI discontinuation 1
• Immediately resuming full-dose PPI creates a cycle of dependence that makes future discontinuation even harder 1

Watch for true alarm symptoms that would require medical re-evaluation:

• Trouble or pain swallowing food, vomiting with blood, or bloody/black stools 3
• Chest pain with shortness of breath or lightheadedness 3
• Unexplained weight loss or persistent severe stomach pain 3

Your current symptoms (isolated post-meal dizziness without these alarm features) do not warrant resuming continuous PPI therapy or urgent medical evaluation 1, 3.

Why This Approach Is Evidence-Based

The 2022 AGA Clinical Practice Update on PPI de-prescribing specifically addresses your situation:

• Either tapering or abrupt discontinuation are reasonable strategies, and your 2-week taper was appropriate 1
• Patients should expect upper GI symptoms during withdrawal and understand this doesn't necessitate immediate return to continuous PPIs 1
• The physiologic basis (parietal cell hyperplasia regression taking 2-6 months) explains why symptoms can emerge or persist during this window 1

Your gastritis was appropriately treated with 3 weeks of esomeprazole 40 mg daily (standard duration for uncomplicated gastritis is 4-8 weeks) 4, 5, and the resolution of your primary symptoms confirms healing 1.