Refractory Gastro-Oesophageal Reflux Disease can be Frustrating, For both Patient and Practitioner (Refractory Gastro-Oesophageal Reflux Disease: A Major Management Issue in Clinical Practice (Report‪)‬

Refractory oesophagitis (non-healing of erosions) is rare since the advent of potent gastric acid inhibition with proton pump inhibitors (PPIs). However, refractory gastro-oesophageal reflux disease (GORD) symptoms, both typical and atypical (cough, chronic hoarseness, asthma and atypical chest pain), have become a substantial clinical problem that is most prevalent in patients with non-erosive reflux disease. What defines GORD as refractory to treatment is controversial. Some clinicians believe that only patients with an incomplete response or lack of response to PPIs twice daily should be considered as PPI failures, while others regard a lack of symptomatic response to once-daily PPI as sufficient evidence. The frequency and/or severity of GORD-related symptoms are likely to vary between patients, making it difficult to decide which symptomatic burden fulfills the definition of refractory GORD. Therefore, a too restrictive definition of refractory GORD may exclude many true sufferers. (1)