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Five conditions—achalasia, eosinophilic oesophagitis, belching and rumination disorders, gastroparesis, and Zollinger–Ellison syndrome—can mimic refractory GERD, making targeted diagnostic testing essential when PPI therapy fails.
In modern gastroenterology, persistent reflux-like symptoms despite optimized proton pump inhibitor (PPI) therapy present a recurring clinical dilemma. While treatment failure is frequently presumed to stem from unmanaged acid exposure, mounting clinical evidence indicates that alternative or overlapping non-acid pathologies are often the primary drivers of symptom persistence.
A review of selected literature indexed in PubMed highlights five major gastroesophageal reflux disease (GERD) mimickers that demand specialized diagnostic toolkits rather than a heavier prescription pad:
Persistent reflux symptoms in the face of optimized PPI therapy must never trigger a default escalation of acid suppression. By moving beyond a one-size-fits-all approach and deploying advanced physiologic, endoscopic, and manometric testing, clinicians can finally decode the true root cause—sparing patients unnecessary procedures and aligning intervention directly with the underlying pathophysiology.
Journal of Education Health and Sport
Diagnostic Challenges in Unusual Causes of Refractory GERD-Like Symptoms
Gabriela Jankowski et al.
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