title: Refractory gastro-oesophageal reflux disease: diagnosis and management.
abstract: Refractory gastro-oesophageal reflux disease (GORD) is described when reflux symptoms have not responded to 4-8 weeks of proton pump inhibitor therapy and occurs in a heterogeneous mixture of patients. The causes of refractory GORD include inadequate acid suppression, non-acid gastro-oesophageal reflux, and non-reflux causes of GORD symptoms including achalasia, gastroparesis and functional heartburn. Upper gastrointestinal tract endoscopy should initially be performed to identify the presence of oesophagitis, and exclude other diagnoses including eosinophilic oesophagitis and peptic ulcer disease. Patients with refractory symptoms but with a normal upper endoscopy are more difficult to diagnose and may require ambulatory pH monitoring, impedance testing, oesophageal motility tests and gastric emptying scans. The primary goal of treatment is symptom reduction and eventual elimination, which can be achieved with proper identification of the underlying cause of the symptoms.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Liu
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
mesh_terms: D002985:Clinical Protocols; D003937:Diagnosis, Differential; D003938:Diagnostic Techniques, Digestive System / Q000639:trends*; D004351:Drug Resistance; D020776:Endoscopes, Gastrointestinal; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors