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Proton pump inhibitors (PPIs) are the best medicaltherapy for patients with gastro-oesophageal reflux disease(GORD), as they control symptoms and heal oesophagitisin about 80% of the cases [1] . Despite this highdegree of efficacy, a substantial part of the patients remainssymptomatic on once-daily PPI, and this is particularlytrue for those with non-erosive reflux disease(NERD). Although there is no universal agreement onthe definition of PPI failure in terms of frequency andseverity of symptoms, an incomplete or unsatisfactory responseof them to a full course of PPIs can be empiricallyaccepted as ‘refractory GORD’

Proton Pump Inhibitor Failure: Why Does It Occur and How Can It Be Managed?