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.