TableĀ 1

Diagnostic possibilities for refractory reflux symptoms

Non-GORDDelayed gastric emptying (common)
Motility disorder: achalasia (common)
Functional (common): normal reflux burden, no symptom/reflux correlation
Aerophagia (less common)
Rumination (less common)
Eosinophilic oesophagitis (if dysphagia is present)
Weakly acidic/non-acidic refluxMay occur after acid suppression in context of regurgitation due to mechanical failure (large hiatal hernia)
Insufficient acidic suppressionDosing (common)
Compliance (common)
Zollinger-Ellison syndrome (rare)
PPI resistance (less common)
Reflux sensitivityReflux burden is normal but patient has a clear symptom/reflux correlation. This is dependent on visceral hypersensitivity and hypervigilance
  • PPI, proton pump inhibitor.