@billgil - you are wise to avoid surgery for a hiatal hernia. My surgeon said the hernia repair surgery can cause more problems than living with the hernia.

Before giving up on the PPI, maybe see if you're having a temporary flare-up of symptoms. Could something else have caused the flare-up: did you lift something very heavy (that happened to me), or have stress or changed habits or the like? You shouldn't stop the PPI or you'll have rebound reflux too. I had to increase my meds and in addition to Nexium in the morning am taking famotidine at night. Hasn't completely relieved the symptoms but it's better than before. If you've had stress there are lots of things to try (exercises, physiotherapy, muscle relaxers) that could release the pressure on the diaphragm (to better close the sphincter and prevent the acid reflux). I also suggest you don't rush to surgery.

I have been on acid blockers since 1986 and run through them all as new ones came on the market. I got little relief until Nexium came out and have been on it for 20+ years now. I take a 20mg in the morning and a 20mg at bedtime. I have finally started to get through my days and nights without GERD and vomiting every day. Over the years Doc's have tried to change me to Pepcid + Nexium and the pepcid at bedtime was just useless. I think to some extent everyone's system has a bit different damage and reacts differently to the medications on the market. You have to find what works for you. That also has to include going with smaller meals more often or something in your stomach at bedtime, or not. Also it's important to stay regular. If you find yourself constipated over a few days, the food you are consuming is not leaving your stomach and becomes more likely to give you reflux. It's the reflux with acid burning your esophagus throat, and the enamel off your teeth that cause so much damage over the years.