Understanding Refractory GERD: New Insights from Rome IV Criteria

Refractory GERD remains a common and challenging issue for many patients, with multiple underlying causes. While the focus has traditionally been on residual reflux, whether acidic or nonacidic, recent advances in understanding have introduced new concepts. The Rome IV criteria now includes reflux hypersensitivity and suggests that GERD can overlap with functional esophageal disorders. Studies have shown that nearly three-quarters of GERD patients who do not respond to once daily proton pump inhibitors (PPIs) may actually have a functional esophageal disorder contributing to their symptoms.