title: Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy.
abstract: About one-third of patients with suspected gastro-oesophageal reflux disease (GERD) do not respond symptomatically to proton pump inhibitors (PPIs). Many of these patients do not suffer from GERD, but may have underlying functional heartburn or atypical chest pain. Other causes of failure to respond to PPIs include inadequate acid suppression, non-acid reflux, oesophageal hypersensitivity, oesophageal dysmotility and psychological comorbidities. Functional oesophageal tests can exclude cardiac and structural causes, as well as help to confi rm or exclude GERD. The use of PPIs should only be continued in the presence of acid reflux or oesophageal hypersensitivity for acid reflux-related events that is proven on functional oesophageal tests.
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Daphne
authors: D
authors: Ang
authors: Care and Health Integration, Changi General Hospital, Singapore.
authors: Choon How
authors: CH
authors: How
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Tiing Leong
authors: TL
authors: Ang
mesh_terms: D002637:Chest Pain / Q000209:etiology; D004947:Esophagus / Q000187:drug effects; D005762:Gastroenterology / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D006356:Heartburn / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008019:Life Style; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
chemical_list: D054328:Proton Pump Inhibitors
keywords: GERD; acid reflux; non-acid reflux; pH-impedance; reflux hypersensitivity