Sorry to hear that your husband is having these issues but i can certainly appreciate the situation. I am 40, have Barretts and also a hiatal hernia. I was in exactly the same position and was also in desperate pain a few months ago I found that I had to make some immediate and drastic lifestyle changes to get things under control--and that is the key, especially if you have Barretts. I'd be happy to share how I was able to get my symptoms under control, though I suppose everyone's situation is a little different. There are a lot of natural aides and tricks that I found useful and definitely keeping a daily of food triggers is very important. Stay on the PPI's and stay consisent. It was your comments about exercise and anxiety that caught my eye. A few questions for you. You mention he has trouble excercising--what time of day is he exercising? What types of excercises? Some suggestions: Excercise in the morning before eating anything. Stick with low impact cardio equipment like elipticals--STAY AWAY from treadmills/road running and other impact cardio for the time being. In fact, if he is tha much pain--light walking is all he should be doing. If you use a bike-use an upright versus recumbant. If he is doing strength training--make sure they are Hiatus Hernia safe exercises as some exercises can make the situation and pain worse. Stress and anxiety is a huge contributor to GERD and it can be a vicious circle. Some suggestions for night time: Don't eat 3 hours before bed, sleep with upper torso (waist-up) elevated, don't use AMBIEN!--stick with someting natural to aid in relaxtion like Calms Forte by Hylands or Melatonin supplements--both available in most drug/health food stores. I'd also recommend structured deep breathing exercises for 15 minutes before bed. Not only can it lower blood pressure immediately (and continously if you do it every day) --it should allow him to completely relax and be ready for sleep.
By the way--I have put off Nissen surgery for now but am having a procedure (Halo 360) to eliminate the Barretts later this month.