Management of Gastroesophageal Reflux Disease that does not Respond Well to Proton Pump Inhibitors

Tiberiu Hershcovici and Ronnie Fass


Curr Opin Gastroenterol. 2010;26(4):367-378. 

In This Article


What constitutes refractory GERD remains an area of controversy. Most investigators believe that only GERD patients who exhibit partial or lack of response to PPI twice daily should be considered PPI failures, whereas others suggest that lack of satisfactory symptomatic response to PPI once a day is a sufficient criterion for PPI failure. The latter definition is much more relevant to pharmaceutical companies and third-party payers, because there is no GERD-related indication for prescribing PPIs twice a day. Furthermore, it is unclear what symptom burden during PPI consumption fulfills the definition of refractory GERD. This is likely to vary from one individual to another. Because refractory GERD is a patient-driven phenomenon, PPI failure patients who seek medical attention will exhibit different frequency and/or severity of GERD-related symptoms. Consequently, any attempt to narrow the definition of refractory GERD might exclude many true sufferers.[8]