Patients who experience refractory GERD usually fall into one of two groups:
- those who need more aggressive treatment
- those who have other causes of their reflux symptoms
More Aggressive Treatment of Refractory GERDSome patients do not respond as well as hoped with the traditional doses of PPIs, so your physician may consider increasing your dose and upping its frequency from once daily to twice a day.
Surgery is another potential option, and those who have the best outcomes from anti-reflux surgery are those who have previously responded to medications. Still, the results can't be strongly counted on.
A physician will weigh the possible risks and complications of the surgery against the possible benefits, and discuss with the patient whether surgery is a good option.
Other Causes of Reflux SymptomsWhen a patient doesn't respond to anti-reflux treatments, especially after more aggressive treatment is tried, other problems besides GERD may be the cause.
Refractory GERD is rare. If you experience continued reflux symptoms despite treatment, consult a gastroenterologist consulted. Discussing the type of symptoms experienced, reporting their frequency, and keeping track of possible reflux triggers will aid in finding an appropriate treatment plan. In some cases, other procedures or tests -- such as endoscopy or a CT scan -- may be necessary, as refractory GERD can be a symptom of a more serious disease (such as esophageal cancer or CREST syndrome).
Ikuo Hirano, M.D.,1 Joel E. Richter, M.D., "ACG Practice Guidelines: Esophageal Reflux Testing." doi: 10.1111/j.1572-0241.2006.00936.x. American College of Gastroenterology. 9 Nov 2009.
Kenneth R. DeVault M.D., F.A.C.G, Donald O. Castell M.D., M.A.C.G.. "Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease." doi: 10.1111/j.1572-0241.2005.41247.x. American College of Gastroenterology. 9 Nov 2009.