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Oesophageal Patients Association
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I'm 20 months post Iver Lewis and have recently reduced my Omeprazole intake to 20mg/day. I have been told to take this first thing in the morning, 30 mins before breakfast but recently told that it is far more effective to take late at night, as it is during the night that you produce more acid.

Does anyone have any conclusive information about this please? I only get bile reflux occasionally but when I do it can make me sick for 2/3 days, so would like to know if it makes a difference.

12 Replies

I thought ppi's were only effective against acid reflux, not bile. Perhaps someone with a bit more knowledge, will be able to help.


I came off ranitidine and omneprazole and so long as I sleep leaning up have no problems. When I do get reflux I take a gaviscon type product . Clearly we are all different but the comment by magpuss is relevant I suspect.


Hi i am 12weeks post op, was changed over to lansoprazole 30mg which take in morning. I too get bile reflux at night and Dr prescribed Gaviscon Advance which does help at night. Before op i used to take Omeprazole 20mg day and night.


There was an article a few years ago about the importance of 'taking heartburn medicines before breakfast for best effect'


I am copying a couple of extracts from this paper below, and it appears that according to this, your doctor giving this advice had good authority for doing so. (Prilosec is another name for Omeprazole):

"Many people with heartburn aren't taking their acid-reducing medicine at the right time, which makes the drugs less effective and wastes money, according to new research.

Only about one-third of those buying these medications -- such as Nexium, Prevacid and Prilosec -- over-the-counter used them properly compared to just under half of those who were prescribed the drugs by their primary care doctor. Those who were given a prescription by a gastroenterologist were most likely to use the drugs as they're supposed to be used, with seven out of 10 taking the drugs properly, according to the study.

These drugs are activated once in the body, said the study's senior author, Dr. M. Michael Wolfe, a gastroenterologist and chair of the department of medicine at MetroHealth System. "In order to activate the medicine, you must eat. For that reason, you take it before breakfast. If you don't take the drug correctly, you don't do as well," Wolfe said.

Despite labels advising users to take the drugs before breakfast, people aren't following those directions, he said. Those who aren't taking the medicines properly "are wasting money, they're not feeling well and they aren't getting symptom relief," Wolfe added.

.......Dr. John Lipham is director of the Digestive Health Center at Keck Medicine of the University of Southern California. Lipham reviewed the findings but was not involved in the study.

"It's something we have known since these medications came out, that they work best if you take them 30 minutes or so before a meal," said Lipham.

However, he pointed out that the new study puts some data behind what experts knew from experience.

Lipham said the new study is the first, to his knowledge, to show a difference in taking the medicine correctly depending on who prescribed it.

Wolfe and Lipham both find that patients often think of the proton pump inhibitors in the same way as antacids, meant to be taken when heartburn strikes.

"But these [proton pump inhibitor] medicines don't work that way," Lipham said. "They need to be stimulated by acid and need to build up in your system. You have to take them at the correct time each day and you also need to take them every day to get the maximum effectiveness of the medications."


This study had to bear in mind that sometimes PPI medication is bought over-the-counter (and it will not have been geared towards those who have had oesophagectomies, but I imagine the principle would be the same).

In a nutshell, the full effectiveness of the PPI medication builds up over a period of a week or so, and the way one takes them is different from an antacid, or an alginate like Gaviscon that you can take from time to time according to whether you have the symptoms or not.

There may be doctors who prescribe the timings differently and there may be a good reason for doing so (eg a smaller dose taken more than once a day, perhaps) but it seems likely that there is a difference between taking PPIs like Omeprazole on a longer term basis to switch off stomach acid production; and dealing with individual spikes of reflux, especially when lying down at night, when Gaviscon or an antacid might do the trick. Gaviscon should work against acid and bile.

If you are suffering from the effects of bile reflux, taking an antacid might make it worse. And to cope with more severe, or prolonged bile reflux, other medication (like cholestyramine) might be effective, but you and the doctor need to be careful about this to make sure that it is targetted properly because the acid is opposite to the alkali and one might affect the balance of the other.

That is my understanding of things, but feel free to take all this with a pinch of salt because I am not medically qualified and am not a pharmacist.

1 like

This was an excellent reply. I had a hiatus herniia and Barrett's oesophagitis and my tablets have always been in a blister pack

I had often had my breakfast before the carers came so the Omeprazole was in the blister pack and therefore was not working. Last week I had a severe heartburn so much so that my doctor called for an ambulance. However thankfully it was not a heart attack which I knew it wasn't. As it was so bad the doctor prescribed Mucagel which relieved the pain. It was only after looking on the internet and people who were on Omeprazole that I realised it must be taken before you eat anything. I have been prescribed different medications but have made an appointment with my doctor to discuss my medication. I am sure this reply will be of great benefit to anyone who has been like me, unaware of the precise time of taking Omeprazole. I know now having managed to find information about the product that perhaps doctors might explain how Omeprazole works just as this reply does. I am sure this reply will be of great use to people starting on Omeprazole or myself not understanding the time and also that you should a large glass of water with it.


I have a hiatus hernia which caused excessive acid and reflux and have been taking omeprazole first thing in the morning as the doctor told me, for 6 years and it's great. I have never had any further problems with reflux.

The effect of each capsule lasts over until the next day for me so I do not need to take another, however there have been a small number of occasions over the years, perhaps 4 times, when I have eaten something in the evening which didn't agree with me and I just took another capsule. My doctor said this is ok and not a harmful overdose or anything like that.

They are the best capsules discovered for me and keep my digestive acid normal.

Regards Jamie


I used to take one 30 mg lansoprazole in the morning but found by the time I went to bed the effectiveness was wearing off. I spoke to my doctor and now take a 15mg in the morning and a 15mg at night and find this works for me.


Hi Makulit

I am also about 12 months post ivor lewis and docs also tell me to take it in the morning. The long term effect for taking in the morning is good because u will get less long term side effects. This is what I was told. I am also taking the same dosage.

I think we should not eat very late into the night.


Mmm I was advised ( by dietician ) to take it an hour before bed ...


My husband is now 6 years post Ivor lewis and has always taken it before bed and it helps


I'm on Omeprazole 2 x 20mg as required. I don't use it very often - perhaps once a fortnight. Find it helps. Not sure I'm helping with your question.


I am 5 and half years post op for a total gastrectomy and been on Omeprazole all that time initially 2 x40mg a day reduced to 2 x 20mg a day taken morning and bed time. In all that time I have suffered with bile reflux irrespective of the omeprazole. The bile reflux seems to have improved over the years at night as used to get it every night about an hour after going to bed but nowhere near as much nowadays .I have to lay upright and recently got an adjustable bed that is an improvement over 3 or 4 pillows for sure. I do get days when it hits me really badly and I am reaching and reaching wondering where it is all coming from. I recently stopped taking the omeprazole to see if there is any difference and been doing this now for couple of weeks only so bit early to say what the outcome is but so far it is no different to taking the omeprazole. I would not tell anyone to stop medication suggested by hospital or doctor as all these things are on an individual basis as to how things affect them



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