Question: I’ve been taking pantoprazole 40 mg and an H2 blocker at night (formerly nizatidine, now famotidine 40 mg) for around ten years. My original indication was difficulty swallowing. On endoscopy, my GI noted reflux esophagitis, some vertical furrowing and concentric rings. No structures or narrowing. Biopsies were negative for Barrett’s, but showed eosinophilic esophagitis.

I have been advised to try an elimination diet and go for allergy testing as well as swallowed fluticasone for the EoE.

My main symptom was difficulty swallowing. The acid control therapies seemed to help with that, as did dilation of the esophagus. Recently, I switched gastroenterologists after my former GI retired. The current GI advised against further dilation and instead pushed me toward the allergist/elimination diet route.

My question concerns the long term course of PPIs/H2 blockers. Discomfort from GERD alone is tolerable, however the difficulty swallowing bready and meats is not. I do not wish to develop Barrett’s, but I am sensitive to the increasing media attention to the risks of kidney disease and, potentially, gastric cancers, from PPIs.

This is a concerning spot to be in: choose between taking PPIs long term to prevent Barrett’s/esophageal cancer, or stopping PPIs to reduce risk of kidney disease and gastric cancer.

Any thoughts on this topic, as well as my history of illness would be welcome. Thank you.