It's a valid frustration. The timeline varies, but generally:

• The drug-induced worsening of reflux is most pronounced during dose escalation (first 3-4 months)
• The weight-loss benefit for GERD typically becomes apparent after 10-15% body weight loss, which for most patients takes 4-6 months
• By month 6-9, most of my patients report their reflux is either at baseline or improved versus pre-treatment

In the interim, a PPI provides a bridge. Think of it as temporary support while your body transitions. If you had significant GERD before starting, I would proactively start a PPI at the time of GLP-1 initiation rather than waiting for symptoms to worsen.

One more consideration: if reflux is truly severe and refractory to PPIs while on the GLP-1, slower titration gives the GI tract more time to adapt at each dose level.

Practical tip: famotidine (Pepcid) 20 mg at bedtime in addition to a morning PPI was the combo that finally controlled my nighttime symptoms. My GI doc calls it "double coverage" — PPI in the morning, H2 blocker at night. Works much better than either alone for nighttime reflux.

Also — sleep on your LEFT SIDE. Anatomy of the stomach means left-side sleeping reduces reflux compared to right-side. Small thing but it helped me immediately.

Thank you all. Started omeprazole 20 mg this morning per my doctor's advice (called today), ordered a wedge pillow, and going to try the no-eating-after-6pm rule. Also going to slow my titration — I was supposed to go up to 1.7 mg next week but my doctor agreed to stay at 1.0 mg for another month.

The reassurance that this is likely temporary and will improve as I lose more weight helps a lot. I was about to quit.