Evaluation and Management of Refractory Gastroesophageal Reflux Disease

John E. Pandolfino*, Sabine Roman

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter


Even if proton pump inhibitor therapy is highly effective for gastroesophageal reflux disease, a substantial number of patients do not respond to optimized therapy. This group of proton pump inhibitor non-responder patients is heterogeneous in terms of the mechanism behind the generation of symptoms. Four phenotypes of proton pump inhibitor non-responders should be distinguished. Phenotype 1 corresponds to persistent acid reflux despite proton pump inhibitor therapy, phenotype 2 to non-acid reflux, phenotype 3 to functional overlap with gastroesophageal reflux disease and phenotype 4 to functional heartburn. Esophageal pH monitoring off therapy and pH impedance monitoring on proton pump inhibitor are the main physiological tests used to distinguish these phenotypes. Whereas phenotypes 1 and 2 may benefit from more aggressive anti-reflux therapy, alternative treatments triggering visceral sensitivity may be offered to patients with phenotypes 3 and 4.

Original languageEnglish (US)
Title of host publicationPractical Manual of Gastroesophageal Reflux Disease
PublisherJohn Wiley and Sons
Number of pages18
ISBN (Print)9780470656266
StatePublished - Jan 25 2013


  • Compliance
  • Functional
  • Optimized therapy
  • PH impedance monitoring
  • Persistent acid reflux
  • Proton pump inhibitor non-responder
  • Visceral sensitivity

ASJC Scopus subject areas

  • General Medicine


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