Patients with refractory reflux symptoms often do not have GERD

Area of Science:

• Gastroenterology
• Digestive Health
• Esophageal Disorders

Background:

• Persistent reflux symptoms despite proton pump inhibitor (PPI) therapy may indicate conditions beyond gastroesophageal reflux disease (GERD).
• Accurate diagnosis is essential for patients refractory to standard acid-suppressive treatment.

Purpose of the Study:

• To investigate the underlying causes of persistent reflux symptoms in patients unresponsive to PPI therapy.
• To differentiate between GERD and other functional gastrointestinal disorders in a tertiary referral setting.

Main Methods:

• Analysis of 106 patients with PPI-refractory reflux symptoms undergoing 24-h pH-impedance monitoring.
• Exclusion of patients with pre-existing diagnoses, prior surgery, or significant gastroscopy findings other than hiatus hernia.
• Esophageal manometry was performed to assess motility disorders.

Main Results:

• 69 patients (65.1%) were diagnosed with GERD.
• 32 patients (30.2%) were diagnosed with functional heartburn (FH).
• Other diagnoses included functional chest pain, achalasia, and rumination. A trend linked FH to epigastric pain and functional dyspepsia.

Conclusions:

• Approximately one-third of patients with refractory reflux symptoms have non-GERD related disorders, primarily functional heartburn.
• These findings highlight the importance of considering alternative diagnoses when PPI treatment is ineffective.
• Identifying functional heartburn and other conditions explains treatment failures and guides appropriate management strategies.