PPIs (proton pump inhibitors) reduce the amount of acid made by your stomach and are commonly used to treat reflux disease. Yet, despite treatment with PPIs, some patients with gastro-oesophageal reflux disease (GORD) continue to have reflux symptoms.

It is estimated that between 10 and 40 per cent of patients with GORD fail to show improvements with their symptoms after taking PPIs – this is referred to as refractory reflux (Note: the definition of the word ‘refractory’ is something stubborn or unmanageable).

Many patients with reflux who do not respond to a PPI will have one of the following conditions:

1) non-erosive reflux disease (NERD) – this is when they have similar symptoms to GORD/GERD but there are no signs of injury to the oesophagus during an endoscopy – or
2) functional heartburn (FH), which is defined as the presence of the same heartburn symptoms that are caused by reflux disease but without any evidence of abnormal oesophageal acid exposure.

According to the “Distinction between patients with non-erosive reflux disease and functional heartburn” 2013 research paper, NERD is the more common manifestation of gastro-oesophageal reflux disease than functional heartburn but both have a common predominant symptom of heartburn.

What can be done?
Medical professionals who face patients with persistent symptoms despite taking a PPI once daily are advised to firstly:

1) Ensure PPI doses are taken correctly, such as 30 minutes before a meal and on a regular basis.
2) Suggest lifestyle changes
3) Consider alternative diagnoses, such as oesophageal motility disorder or gastroparesis

How can Peptest help?
Peptest can help to ensure that those people with reflux symptoms really do have reflux disease. Peptest is particularly useful in distinguishing between patients with NERD and functional heartburn and thus ensuring patients get the right care and treatment for their specific condition.

Patients with NERD will still be refluxing gastric contents and thus will provide positive samples on analysis using Peptest. It is important to understand that Peptest will detect reflux whether the gastric contents are acidic or not.

Patients with functional heartburn, by definition, will not reflux gastric contents and thus will have negative Peptest results. For these patients the clinician should be looking for another cause of the heartburn-like symptoms.

Where can I find out more about refractory reflux?
You can read more detailed information on refractory reflux in the ‘Approach to refractory gastroesophageal reflux disease in adults’ article on UpToDate, the evidence-based, physician-authored clinical decision support resource.