title: Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies.
abstract: BACKGROUND
  Persistent gastro-oesophageal reflux disease (GERD) symptoms can occur despite proton pump inhibitor (PPI) therapy.
  
  
  OBJECTIVE
  To assess the prevalence and potential determinants of persistent GERD symptoms in primary care and community-based studies.
  
  
  METHODS
  Studies were identified by systematic PubMed and Embase searches; pooled prevalence data are shown as sample-size weighted means and 95% confidence intervals.
  
  
  RESULTS
  Nineteen studies in individuals with GERD taking a PPI were included. In interventional, nonrandomized primary care trials, the prevalence of persistent troublesome heartburn and regurgitation was 17% (6-28%) and 28% (26-30%) respectively; in randomized trials, it was 32% (25-39%) and 28% (26-30%), respectively. In observational primary care and community-based studies, 45% (30-60%) of participants reported persistent GERD symptoms. Overall, persistent GERD symptoms despite PPI treatment were more likely in studies with a higher proportion of female participants [>60% vs. <50%, risk ratio (RR): 3.66; P < 0.001], but less likely in studies from Europe than in those from the USA (RR: 0.71; P < 0.001), and were associated with decreased psychological and physical well-being.
  
  
  CONCLUSIONS
  Persistent GERD symptoms despite PPI treatment are common in the primary care and community setting. Alternative approaches to management are required.
authors.affiliation: Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. hasheme@bcm.tmc.edu
authors.forename: H
authors.initials: H
authors.lastname: El-Serag
authors.forename: A
authors.initials: A
authors.lastname: Becher
authors.forename: R
authors.initials: R
authors.lastname: Jones
mesh_terms: D002986:Clinical Trials as Topic; D003153:Community Health Services; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors