isergodur, I have both reflux and gastritis and there are times when the reflux gets worse even though I haven't changed my diet, etc. I used to have to change PPIs every year or so or they stopped working, but I've been on Protonix for quite a while now and just have to bump it up to twice a day for a while when it starts getting really bad. Not sure why it does it, but it usually calms itself back down. It's been bad lately, but I'm also having a lot of stomach spasms right now as well, so we have an endoscopy scheduled for next month.