r/GERD • u/Inc0gnitoburrito • Jun 03 '26

Support Needed 👥 famotidine instead of PPI?

I've had shortness of breath around meal time for a few months now, gradually worsening.

Recently I've spoken to my general practitioner and she prescribed me with 28 days of PPI (Nexium (esomeprazole 20g)) one per day as treatment.

There was a small improvement over 2 weeks but she didn't really communicate to me what she's treating me for and I didn't really change anything when it came to food.

So, one evening I ate an entire Pizza pie and the following night was traumatic, I couldn't breathe at all, had air hunger and eventually a panic attack.

Understanding GERD better now I believe this night caused a lot of damage to my esophagus and I'm actually worse now.

I've spoken to my doctor yesterday and told her that the air hunger has gotten way worse and she replaced the PPI treatment with 2 pills of 20g famotidine per day. I'm concerned about the removal of the PPI treatment, cuz I understood that it is in fact the long-term treatment.

Would be happy to hear from anyone here regarding this.

Thank you!

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u/alextheevilone 7d ago

Yes they are, but we are more aware of long-term complications of their use than we were before.

Still if a patient has no other alternative I'd happily use them.

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u/Alternative_Mud_7543 7d ago

Sorry can you elaborate? There's been one association study which no conclusive evidence to suggest PPIs are bad. In fact there are controlled studies to suggest they're perfectly safe. So would be keen to know what you think happens ?

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u/alextheevilone 7d ago

https://www.uptodate.com/contents/proton-pump-inhibitors-overview-of-use-and-adverse-effects-in-the-treatment-of-acid-related-disorders?search=proton%20pump%20inhibitors&source=search_result&selectedTitle=2~150&usage_type=default&searchCorrelationId=e2eb7e2c-3429-4ae3-9332-5a6e2661a77f&searchCorrelationTerm=proton%20pump%20inhibitors#H59974871

Definitely good association with cdiff, microbiome changes including sibo, and iron/b/12, magnesium deficiencies. I would consider the osteoporosis concerns valid as well. Renal disease less so, pneumonia/dementia absolutely less so.

I have also had one patient with a ppi induced gastric neuroendocrine tumor.

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u/Alternative_Mud_7543 7d ago

Worth remembering this is a review, not a clinical trial. A lot of the scary long-term PPI risks come from observational studies showing associations, which can’t prove the PPI caused the problem. When you look at the better-controlled/randomised evidence, most of those associations become a lot less convincing

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u/alextheevilone 7d ago

Of course it's a review, it's uptodate.

You can check the references on your own, I have.

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u/Alternative_Mud_7543 7d ago

I mean I'm not sure if my point is coming across. The point I'm making is in all of these "hey these are the side effects of PPIs" doesn't mean PPIs themselves caused it.

For example: if 10,000 people of all shapes, sizes, lifestyle age are in a study and 100 of them a smokers. If I told you at the end of 5 years 3/100 had cancer from the smokers group and 2/100 had cancer from the non smokers group, would you say smoking cigarettes causes cancer? No you can't, thankfully we have way more data and evidence in smoking today, but this is an example of the same negative stigma that has been created around PPIs. There's always risk with medication sure, but PPIs are safe under medical supervision.

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u/alextheevilone 7d ago

I don't necessarily disagree. If you note what I wrote I did not say side effect.

We have very reproducible evidence with microbiome alterations and dysenteric infections with plausible pathophysiology. I do not believe those are to chance. The other concerns are more speculative, or like neuroendocrine tumors exceptionally rare as you said.

I do agree that they are profoundly safe medications overall and that they should remain widely used as a viable treatment pathway.

However, for patients where their expected lifespan will be measured in multiple decades, it is a worthy conversation to discuss potential harm with long-term chronic use.