Hi Emily
H2’s like Zantac and PPI’s operate at different levels so its probably like comparing apples to oranges to some degree. At at theoretical level it is possible that Zantac can be as effective as PPIs at controlling acid, they just use different mechanisms. both don’t totally eliminate acid. However at a practical level the problem seems to be that the body becomes used to Zantac and you need an ever increasing dose to have any effect (until they literally outgrow their dose). On the other hand it doesn’t seem that infants become “used to ” PPIs to the same extent. I think the right dose of PPI therefore is probably superior to Zantac on its own.
It is possible still that there is breakthrough acid even on PPI’s because they don’t shut of all pumps. This is probalby why people add Zantac or another antacid into the mix to try and “mop up” this extra acid. There is also the possibility that there is “non-acid reflux” occuring. So I think it is pretty complex.
Maybe you could try a good dose of a PPI with something else at night- mylanta/gavisson/pepcid complete/Zantac?
It is hard when they seem to be OK sometimes and then reflux at others.
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