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In a recent version of Gut, Mainie and colleagues report on patients with persistent symptoms despite acid suppressive therapy.1 This is often presented as a considerable problem and impedance seems useful in the evaluation of these patients. The importance of the phenomenon of proton pump inhibitor(PPI)-refractory symptoms is also stressed in studies in which the need for a new anti-reflux drug is propagated. However, we think some caution is appropriate when speaking of PPI-refractory gastro-oesophageal reflux disease …
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