I have grade 4 erosion of gullet. i have tried, raberprazole, lansoprazole, omerprazole, ranatindine. i vomit up bile mornings. pantoprazole really helped but unable to get in uk anymore. trying to avoid nissen fundoplication operation. any suggestions

Conservative rx: Be sure all conservative measures have been taken such as no eating after dinner, elevation of the head of the bed, avoiding greasy food, garlic, onion, stop smoking, lose weight. The addition of carafate and welchol may be of benefit, welchol binds bile acids, and carafate helps heal erosions. A short course of Reglan (metoclopramide) may help as it increases the tone of the lower esophageal sphincter.