I was diagnosed with NSAID‑induced gastritis five weeks ago, treated with prescription esomeprazole (Nexium) 40 mg daily for three weeks, then tapered for two weeks, and switched to over‑the‑counter esomeprazole 20 mg; now I have post‑prandial dizziness lasting hours, occasional out‑of‑body sensations, and heat flashes without sourness or bloating—could this be rebound acid hypersecretion, insufficient dosing, a side effect of esomeprazole, or recurrence of gastritis?

Your Symptoms Are Most Likely Rebound Acid Hypersecretion from Tapering Esomeprazole, Not Gastritis Recurrence

The dizziness, out-of-body sensations, and heat flashes you're experiencing after switching to lower-dose OTC esomeprazole are consistent with rebound acid hypersecretion—a well-documented phenomenon when reducing PPI therapy—rather than recurrence of your NSAID-induced gastritis, especially since you lack the typical gastritis symptoms of sourness and bloating. 1, 2

Understanding What's Happening

Rebound Acid Hypersecretion is Real and Expected

• Rebound acid hypersecretion occurs when tapering or stopping PPIs and can cause transient upper gastrointestinal symptoms that may feel different from your original gastritis symptoms 1, 2
• This phenomenon is present by 3 days after reducing PPI dose and can last for at least 2 months after treatment courses, though it typically resolves within 10-14 days 2
• The American Gastroenterological Association specifically warns patients discontinuing long-term PPI therapy that they may develop these transient symptoms due to rebound acid hypersecretion 1

Why Your Symptoms Feel Different

• The dizziness, heat flashes, and dissociative feelings you're describing are not typical gastritis symptoms but may represent systemic responses to acid rebound or anxiety about symptom recurrence 1
• Your absence of sourness and bloating—the hallmark symptoms of your original gastritis—strongly suggests this is NOT gastritis recurrence 3
• The timing (immediately after switching to 20mg OTC from 40mg prescription) perfectly aligns with rebound acid hypersecretion 2

What You Should Do Right Now

Immediate Management Strategy

• Return to esomeprazole 40mg once daily immediately to re-establish adequate acid suppression, as the 20mg OTC dose may be insufficient during your healing phase 3, 4
• The American College of Gastroenterology recommends 40mg once daily for a full 8 weeks to ensure complete healing of NSAID-induced gastritis 3
• You switched to OTC (20mg) too early—you were only 5 weeks into treatment when standard therapy requires 8 weeks 3

Critical Tapering Error You Made

• You tapered too aggressively by cutting the dose in half (40mg to 20mg) while still in the healing phase 1, 3
• The American Gastroenterological Association recommends that patients on twice-daily dosing should step down to once-daily PPI first, not immediately to half-dose 1
• Most patients with NSAID-induced gastritis should complete the full 8-week course at 40mg before attempting any dose reduction 3

Proper Tapering Protocol Going Forward

When to Actually Taper (Not Now)

• Complete the full 8 weeks at esomeprazole 40mg once daily first before considering any dose reduction 3
• After 8 weeks, if completely symptom-free, you can attempt a trial withdrawal or step down to 20mg 1
• The American Gastroenterological Association suggests attempting trial withdrawal once symptoms resolve, then resuming PPI on-demand or continuously if symptoms recur 3

How to Taper Correctly

• Either dose tapering or abrupt discontinuation can be considered when the time is right, but gradual tapering may minimize rebound symptoms 1
• If tapering, go from 40mg daily to 20mg daily for 2-4 weeks, then attempt every-other-day dosing before stopping completely 1
• Expect some transient symptoms during tapering—this is normal rebound, not necessarily gastritis recurrence 1, 2

Red Flags That Would Indicate True Gastritis Recurrence

When to Seek Immediate Medical Attention

• Hematemesis (vomiting blood), melena (black tarry stools), significant weight loss, difficulty swallowing, or recurrent vomiting require urgent endoscopy 3
• Return of your original symptoms: epigastric sourness, bloating, and meal-related discomfort would suggest gastritis recurrence 3
• Severe or worsening abdominal pain that differs from your original presentation 3

What You're Experiencing Doesn't Match Gastritis

• Dizziness lasting hours after meals, out-of-body sensations, and heat flashes are not typical manifestations of gastritis or peptic ulcer disease 3
• These symptoms may represent anxiety, vasovagal responses, or other non-gastric issues that coincidentally appeared during your taper 1

Critical Long-Term Considerations

NSAID Avoidance is Essential

• The American College of Gastroenterology and American Gastroenterological Association both recommend avoiding all NSAIDs going forward, as you are now at very high risk for recurrent complications 3, 1
• If you absolutely need anti-inflammatory medication, use acetaminophen, which does not cause gastric injury 3
• If NSAIDs are unavoidable, you would need a COX-2 selective inhibitor (like celecoxib) combined with a PPI 1, 3

H. Pylori Testing is Mandatory

• You should be tested for H. pylori infection immediately if not already done, as it increases NSAID-related complications by 2-4 fold 1, 3
• If positive, eradication therapy (PPI + amoxicillin 1000mg twice daily + clarithromycin 500mg twice daily for 14 days) is required 3

Bottom Line

Your symptoms are almost certainly rebound acid hypersecretion from premature dose reduction, not gastritis recurrence. Return to 40mg daily, complete the full 8-week course, avoid all NSAIDs permanently, get tested for H. pylori, and only attempt tapering after complete symptom resolution for the full treatment duration. The dizziness and dissociative symptoms, while distressing, are not typical of gastritis and may resolve once you re-establish adequate acid suppression. 1, 3, 2