[Differential diagnosis of the refractory gastroesophageal reflux diseases]

Refractory gastroesophageal reflux disease is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Despite bi-daily administration of proton pump inhibitors, reflux symptoms may persist, new symptoms may occur or become unmasked, and oesophagitis can fail to heal. Some of these patients do not take their medications, well-defined pharmacokinetic factors or genetic polymorphisms can contribute, nonacid reflux can be the culprit or their oesophagitis and/or symptoms may not be due to acid reflux. The first investigation to perform in the refractory gastroesophageal reflux disease is the upper endoscopy to exclude the possibility of refractory peptic ulcer disease or, less likely, cancer, and to identify "other" oesophagitis (nonerosive alternative oesophagitis--microscopic oesophagitis).