Practical Approach to Refractory GERD: GI Perspective over the Last 40\u2009Years

Abstract

Refractory GERD patients not responding to BID proton pump inhibitors are often referred for anti-reflux surgery. Over the last 40\u2009years, I have learned the importance of a team approach with comprehensive esophageal testing to appropriately find the patients who will benefit from surgery. All patients need upper endoscopy, high-resolution manometry and prolonged pH testing. Selected patients may need a barium esophagram or gastric emptying testing. All complex cases are discussed at our weekly esophageal conference which includes gastroenterologists, foregut surgeons and swallowing therapists. Ten case scenarios are presented of recurrent themes in patients with “refractory” GERD, many whom don’t have acid reflux.