PPI's may be necessary (OTC) short term. Reflux can be caused by parasites, bacteria (h.pylori) and hiatal hernia. My reflux was being caused by parasites and h.pylori. I've gone thru 2 bottles of Pyloricin (Pharmax) and it helped alot. My reflux is much better. I'm continuing with parasite cleanse and the reflux is getting better.