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Refractory GERD — ESEGH MCQ

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HardGastroenterologyRefractory GERDESEGH

A patient with persistent heartburn on twice-daily PPI has normal endoscopy. On-therapy pH-impedance shows physiological acid exposure, a normal number of reflux episodes and negative symptom association for acid and non-acid events. Which conclusion best guides management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Avoid antireflux escalation because reflux causation is unproven

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

E is correct. Normal exposure, normal reflux burden and negative symptom association do not support ongoing reflux as the symptom driver, so invasive or antisecretory escalation is inappropriate. A contradicts the exposure data. B invents symptom association that the tracing does not show. C incorrectly defines reflux hypersensitivity using negative rather than positive association. D requires motility testing and a compatible phenotype, not pH-impedance alone.

Reference: Lyon Consensus 2.0: modern diagnosis of GERD: https://pmc.ncbi.nlm.nih.gov/articles/PMC10846564/