I have been to 2-3 doctors for GERD who always have written more and more PPIs . I was always told , take it 1st thing in the morning before breakfast.
Today, I had a long talk with a GI doc. (it was a free camp from a company). His comments to make PPI effective were:
1) Take it on empty stomach (make sure you have not eaten or drank except water for 3 hrs before)
2) After taking it wait for 30 min.
3) After 30 min. eat your biggest meal of the day (whether its breakfast, lunch or dinner doesn't matter). Dinner should be the lightest meal though for GERD people.
4) Make sure this meal is atleast 500 Cal. with some protein items.
5) Do not start this meal with milk, tea, coffee, juice etc.
He said, PPI gets ignited by meals. If you take a milk,tea etc after 30 min. of PPI, it will be in-effective.
Usual things like eat dinner no later then 3-4 hrs before sleep, bed elevation, 15 min. walk after a meal , correct BMI/ obesity, active life (with no pulling, bending, pushing etc after meals) and discipline in what to eat were usual stuff.