Lifetime PPI use

Well, my husband is 15 years out RNY. In 2015 he had a gastric bleed and he almost died. His father also had a history of ulcers and that knocked him out of the army in WWII. Our doctor went to bat for him and demanded with Medicare that he be on lifetime PPI, which he now is. It all depends on the situation for each person's health. He would rather be still on earth with a good quality of life instead of worrying about if the other shoe will drop and he will almost bleed to death again. He does not drink caffeine.

I am not sure about the Alzheimer's connection with PPI but my dad had it as did my MIL and neither of them had acid reflux issues.

PS - I had awful reflux issues pre RNY 15 years ago and have not had an incident since then. Everyone's body is different.

With the relatively sudden onset of these symptoms, I would be inclined to look for some physical change, like a hiatal hernia, as a possible cause. There may also have been some other evolutions with your sleeve that may create some shaping issues (minor strictures or bulges) that cause or exacerbate the reflux condition, so some imaging may be in order to see if there are any obvious causes in that department.

On the medication front, H2 inhibitors such as Zantac and Pepcid can give effective relief without (so far, at least) the nastier long term implications. They are less effective and less enduring than PPIs, but may be sufficient, and are often used in combination with PPI in the weaning off process. As with other things, however, symptomatic relief may not equal resolution of the underlying problem, so even if one is getting effective relief, if one is subject to these problems, a periodic EGD would not be a bad idea to make sure that nothing untoward is happening inside.

I am 6 months out from revision to RNY due to acid reflux. Mine started about 3-4 months after I had sleeve surgery. It was gradual at first but over the course of a year got worse. PPI meds would work for a short amount of time and then I had to start doubling up on them. Eventually I was taking 2-3 a day, carafate 4 times a day, chewing tums and nothing touched it. I went from a constant sore throat to barely being able to speak. During this time the pressure from the reflux caused a hiatal hernia. I know how bad the reflux can get and the damage it can do. I encourage you to seek advice from a Gastroenterologist once you get established with a pcp. I lived with the reflux for a year before deciding on revision. I've had no complications since revision and only had a slight B-12 deficiency after that has since been corrected. Waking up from revision surgery with no reflux, no sore throat or heartburn was the best feeling ever. Feel free to message me if you ever have any questions.

On the other hand, my grandfather died of a ruptured esophagus due to untreated acid reflux.

Damned if you do, damned if you don't.