title: Refractory gastroesophageal reflux disease.
abstract: Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms, esophageal injury, and/or complications. Use of proton pump inhibitors (PPI) remains the standard therapy for GERD and is effective in most patients. Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered, according to individual patient characteristics. Response to PPIs could be total (no symptoms), partial (residual breakthrough symptoms), or absent (no change in symptoms). Patients experiencing complete response do not usually need further management. Patients with partial response can be treated surgically or by using emerging endoscopic therapies. Patients who exhibit no response to PPI need further evaluation to rule out other causes.
authors.affiliation: Internal Medicine, Guthrie Clinic, Sayre, PA, USA and Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Charumathi Raghu
authors.initials: CR
authors.lastname: Subramanian
authors.affiliation: Internal Medicine, Guthrie Clinic, Sayre, PA, USA and Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA vagt@stanford.edu.
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
keywords: acid-related diseases; endoscopy; gastroesophageal reflux disease; pH monitoring