Does Nexium (Esomeprazole) Cause Bloating? & How to Prevent It?

Does Nexium cause bloating?

Bloating is not a frequent side effect of esomeprazole (Nexium). Short-term use of Nexium (for a week or two) is less likely to cause bloating. However, Acid suppression from long-term use of Nexium and other proton pump inhibitors (PPIs) can result in overgrowth of the gut bacteria and subsequent bloating.

Bloating was reported in 43% of  GERD patients receiving Esomeprazole (Nexium) 20 mg twice daily for 8 weeks (reference). The condition may be related to Small Intestinal Bacterial Overgrowth (SIBO).

On the other hand, Many People with GERD and gastritis report relief of bloating with Nexium use.

Bloating during Nexium treatment is not necessarily related to the medication. So, It is important to investigate the cause of bloating with Nexium use. Read the next section to learn more about the possible causing of bloating during Nexium treatment.

What are the causes of bloating during Nexium use?

As we explained in the above section, bloating is less common when using Nexium Short-term or on-demand. But long-term use of Nexium may result in SIBO and subsequent bloating.

Nexium can cause bloating by:

  • Inhibition of gastric acid secretion: Stomach acid is an important defensive line against the growth of unwanted organisms in the small intestine and colon.
  • Untreated H. pylori stomach infection: Some studies found that using PPIs such as Nexium can flare-up H. pylori symptoms including epigastric pain and bloating.
  • Long-term Nexium treatment causing Small Intestinal Bacterial Overgrowth (SIBO).
  • Affecting digestion and absorption: Stomach acid is necessary for normal digestion. Decreased stomach acid may result in bloating.

Indirect causes of bloating during Nexium therapy:

  • Disease-related bloating: Some conditions that are treated with Nexium cause bloating. Gastritis, GERD, and peptic ulcer disease can cause bloating.
  • Other drugs causing bloating: You may take other medications with Nexium that cause bloating, for example: (ref)
    • Antacids such as Gaviscon, Maalox, Pepto-Bismol
    • Diarrhea medicines such as Imodium, Lomotil, and Kaopectate.
    • Fiber supplements and bulking agents such as Citrucel, Metamucil, and Fiber.
    • Multivitamins and Iron pills.
    • Opioid pain medicines.
    • Aspirin.
  • Misdiagnosis: Bloating is common with other conditions that resemble gastritis or GERD symptoms. Common diseases that cause bloating include Functional dyspepsia, lactose intolerance, gallbladder diseases, gastroparesis, and Irritable Bowel Syndrome (IBS).
  • Food-related bloating: Wrong dietary habits can lead to bloating during Nexium therapy such as:
    • Drinking coffee or carbonated drinks.
    • Eating fatty or fried foods.
    • Eating large meals.
    • Beans, onions.
    • Broccoli, cabbage, sprouts, and cauliflower.
    • Eating too fast and not chewing the food enough.

How to prevent Nexium from causing bloating?

1- Avoid long-term use without medical guidance.

Long-term use of PPIs including Nexium is most commonly related to bloating and gas. Avoid using Nexium OTC medication for long periods without medical guidance. Long-term use of Nexium can produce other potentially harmful side effects such as (reference):

2- Work with your doctor to reach the lowest effective dose.

Using the lowest effective dose of Nexium can improve the bloating. For example, using Nexium 20 mg instead of 40 mg. Ask your doctor about the best option that fits your condition.

3- Ask your doctor about Nexium on-demand use.

Nexium can be used on-demand to avoid its side effects. However, Stopping Nexium or taking it on demand can do more harm than good.

According to your condition, your doctor is the only one capable of determining what fits you.

4- Consider treating other causes of bloating.

As we explained to you before, Bloating during Nexium treatment can be related to other factors such as food, the original disease, or other medications.

Work with your doctor to define the possible cause of bloating and manage it accordingly.

Also, follow the below general tips to prevent and treat bloating.

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General tips to effectively treat bloating.

  • Avoid gas-producing foods and drinks: such as beans, onions, cabbage, broccoli, sprouts, coffee, carbonated drinks, and alcohol.
  • Don’t eat too-fast: this leads to air swallowing.
  • Don’t eat too much at a time: small frequent meals are better than large one or two meals.
  • Take digestive enzyme supplements such as Lactase enzyme, and Beano (contain alpha-galactosidase enzyme).
  • Ask your doctor about Probiotics: Probiotics are living micro-organisms that can inhibit the growth of harmful gut bacteria and restore gut balance. 
    Several clinical studies showed that probiotics can potentially decrease gas and bloating. However, the results were not consistent across all studies. 
    Ask your doctor about a trial of probiotics if the other measures fail.

When to see a doctor for bloating?

Bloating is usually an ordinary sign of digestive problems related to gut diseases or medications.

See a doctor if you experience:

  • Persistent bloating of undiagnosed cause.
  • Associated with severe nausea or vomiting.
  • Severe constipation.
  • Abnormally severe abdominal pain.
  • Weight loss without explanation.
  • Fever, shortness of breath, or extreme fatigue.