long-term use of pantoprazole

I’m a 22-year-old woman, I weigh 95 kg and I’m 162 cm tall. I currently take sodium divalproate, vortioxetine, venlafaxine, quetiapine, pregabalin, and pantoprazole on a daily basis. I also use sucralfate, though not every day. I’ve been diagnosed with borderline personality disorder (BPD), polycystic ovary syndrome (PCOS), chronic gastritis, and obesity.

Since 2021, when I was 17, I started experiencing daily acid reflux. A doctor prescribed pantoprazole on an empty stomach, and it was the only medication that truly helped. Later, other doctors tried switching me to omeprazole, esomeprazole, and lansoprazole, but none of them worked. I then had an esophagogastroduodenoscopy with biopsy, which only showed chronic gastritis.

My main concern is that I’ve been taking pantoprazole continuously since then (except for a 2–3 month period when I tried the other PPIs). I’m worried about the long-term use, as I’ve been told it should not be taken for more than 4 weeks. Some doctors have warned me about serious side effects such as decreased bone density (osteoporosis) and possible vision problems.

What worries me the most is that if I skip even one dose, I experience unbearable reflux at night. I’ve been advised to change my diet and told that obesity is a contributing factor, but honestly, even though my diet isn’t terrible and I often try to lose weight, I’m not yet ready to completely cut out certain foods. I also struggle with occasional binge eating.

I want to understand why pantoprazole is the only medication that works for me, whether there’s an equally effective alternative with fewer long-term side effects, and whether my symptoms might eventually go away. I would also like to understand why obesity affects reflux so much.