title: Refractory gastroesophageal reflux disease: advances and treatment.
abstract: 'Refractory gastroesophageal reflux disease' is one of the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive proton pump inhibitor therapy. The term should be replaced with 'refractory symptoms.' We must acknowledge that in many patients symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to diagnostic testing. In majority of patients these tests are normal. The role of non-acid reflux in this group is uncertain and patients should not undergo surgical fundoplication based on this parameter. In patients unresponsive to acid suppressive therapy GERD is most commonly not causal and a search for non-GERD causes must ensue.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, C2104-MCN, Nashville, TN, USA.
authors.forename: Fehmi
authors.initials: F
authors.lastname: Ates
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.forename: Michael F
authors.initials: MF
authors.lastname: Vaezi
mesh_terms: D000818:Animals; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000187:drug effects* / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008365:Manometry; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D009626:Terminology as Topic; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors
keywords: achalasia; acid suppressive therapy; functional upper gut symptoms; gastroparesis; refractory symptoms