There are many reasons why you might not respond to proton pump inhibitors (PPIs), ranging from not taking medications as prescribed to having genes that change the way your body metabolizes PPIs.
Gastroesophageal reflux disease (GERD) is estimated to affect anywhere from
Lifestyle changes like quitting smoking and avoiding trigger foods are sometimes enough to improve GERD symptoms. Doctors often recommend medications if changing lifestyle habits alone isn’t effective.
Proton pump inhibitors (PPIs) have been the gold standard medical treatment of GERD for over 25 years. PPIs offer relief for about
Let’s examine potential reasons why GERD may not respond to PPIs as well as treatment options for people who don’t experience significant symptom relief.
GERD is called “refractory” if it doesn’t respond to PPIs for at least
Not taking medications as prescribed
GERD may not respond to PPIs if they’re not taken as prescribed.
PPIs should normally be taken
Not having a response to PPIs can be a sign that you may not have GERD. Esophageal pH monitoring is the gold standard technique for differentiating GERD from other conditions. It involves inserting a tube into your esophagus through your nose for 24 hours.
Other conditions that may mimic GERD include:
- chronic gastritis (stomach lining inflammation)
- atrophic gastritis, usually caused by Helicobacter pylori infection
- Crohn’s disease
- stomach ulcer
- stomach cancer
- esophageal stricture
- Plummer-Vinson syndrome
- nonsteroidal anti-inflammatory drug (NSAID) use
- autoimmune skin disease
- infections like candida or herpes simplex virus
- eosinophilic esophagitis
PPIs are primarily metabolized (processed) by your liver. Genes that change your expression of an enzyme called CYP2C19 can change how your body breaks down and uses PPIs. About
Functional esophageal disorders
Functional esophageal disorders are symptomatic conditions that aren’t caused by a known underlying disease or anatomical condition. The presence of a functional esophageal disorder may complicate GERD treatment.
Functional esophageal disorders associated with GERD include:
Functional heartburn is when you experience GERD symptoms but without the evidence of high acid levels in your esophagus.
Esophageal hypersensitivity is when you are highly sensitive to anything in your esophagus. This can be from sources like stomach acid, temperature, and pressure.
Some underlying conditions may reduce the effectiveness of PPIs. Here are some examples:
- Delayed stomach emptying: Delayed stomach emptying may increase pressure in your stomach, which can increase your backflow of stomach acid.
- Lower esophageal sphincter (LES)difficulties: Your LES is a band of muscle that creates a barrier between your stomach and esophagus. Difficulties with this sphincter can cause acid to leak into your esophagus.
- Weakly acidic or nonacidic reflux: Weakly acidic or nonacidic reflux occurs when the acidity of your esophagus is above the threshold for acid reflux, but you still have symptoms.
Worsening GERD symptoms while on PPIs might be due to rebound acid secretion. Rebound acid secretion occurs when your body produces more stomach acid than before treatment. It’s thought to occur due to elevations in the hormone
Rebound acid secretion primarily occurs when you stop taking PPIs.
If you have GERD that doesn’t respond to PPIs, a doctor may recommend other medications or surgery.
A doctor may recommend:
- double-dose PPIs if you didn’t respond to once a day
- other PPIs
- H2 receptor antagonists
- potassium competitive acid blockers
- GABA agonists
Surgery is considered the last resort treatment. Several techniques are available, such as:
- Fundoplication: Your surgeon wraps part of your stomach called the fundus around your esophagus to reinforce your sphincter. Success rates have been reported from
67–95%of people who receive this treatment.
- Magnetic sphincter augmentation: A magnetic band of metal beads called the LINX device is wrapped around your sphincter to help reduce the backup of stomach acid.
Here are some frequently asked questions people have about PPI-refractory GERD.
What is the strongest PPI for GERD?
Omeprazole was the
What happens if PPIs don’t help GERD?
If you don’t respond to PPIs, a doctor may recommend:
- other medications like H2 blockers
- tests to confirm whether you have GERD or another condition
It’s important to visit a doctor for regular checkups if you’re taking PPIs to treat GERD. It can take a
In a 2021
A doctor may recommend changing medications if you don’t notice an improvement in your symptoms within 2 weeks.
PPIs are the gold standard treatment for GERD that doesn’t respond to lifestyle changes alone. Although PPIs can be effective, many people don’t experience relief.
Not taking your PPIs as prescribed is one of the most common reasons why you may not notice your symptoms improve. Other factors like the presence of underlying conditions and misdiagnosis can also contribute.