I am on Prevacid 30 mg twice a day. You didn't mention your Prilosec dose. If it is at 20mg twice a day, you can go up to 40mg twice a day. If that doesn't work you can add a variety of drugs, such as zantac, pepcid, or carafate. These drugs are then all pushed to their max. I have been on 800mg Zantac a day, and 10cc carafate four times a day. After that, a propulsid such as reglan can be added. I was on Reglan four times a day at 10mg. After that sometimes an antiemetic can be added. I have used compazine and phenergan in this class of drugs. Occasionally after that surgery is persued, though some doctors, such as mine, will flat out not do the surgery, since there have been studies that show less than 10% of the people who have it done are still off drugs a year later, the recovery is tough, and there is evidence that if drugs don't work, surgery won't either.