Hi from Tasmania, I’m on Esomeprazole (ppi) at 60mg daily after having an esophagectomy for cancer of the esophagus, where it joins the stomach. My understanding is that chronic esophageal exposure to stomach acid ( reflux / GERD) may lead to precancerous esophageal cell changes (Barrett’s Esophagus) which then puts you at a higher risk of esophageal cancer. While long term use of ppi’s is not ideal, it is preferable to ongoing reflux. I’m trying to find out if the reported problems with long term ppi use are from the drug itself or from nutrient absorption issues due to reduced gastric acidity. My GP says we need to monitor magnesium and vitamin B12 levels but not to get too concerned otherwise. I don’t seem to have any noticeable side effects from this high dose at this stage. When you have an esophagectomy, the lower esophageal sphincter is removed - that normally acts as a barrier to contain stomach acid. Many, probably most esophagectomy patients are on long term ppi’s at high doses.