Table 4.

Possible Causes of Refractory Gastroesophageal Reflux Symptoms

Non-GERD Functional heartburn Functional dyspepsia Esophageal motility disorder (eg, achalasia) Eosinophilic esophagitis

Insufficient acid suppression Lack of compliance Improper dosing time Reduced bioavailability of PPIs Hypersecretory state (eg, Zollinger-Ellison syndrome)

Weakly acidic or non-acidic reflux Concomitant functional disorder or psychological comorbidity Delayed gastric emptying Reflux hypersensitivity

GERD, gastroesophageal reflux disease; PPIs, proton pump inhibitors.