Proton pump inhibitor failure: why does it occur and how can it be managed?

Proton pump inhibitors (PPIs) are the best medical therapy for patients with gastro-oesophageal reflux disease (GORD), as they control symptoms and heal oesophagitis in about 80% of the cases [1] . Despite this high degree of efficacy, a substantial part of the patients remains symptomatic on once-daily PPI, and this is particularly true for those with non-erosive reflux disease (NERD). Although there is no universal agreement on the definition of PPI failure in terms of frequency and severity of symptoms, an incomplete or unsatisfactory response of them to a full course of PPIs can be empirically accepted as ‘refractory GORD’.