Is there a process physicians should adopt when assessing GERD treatment response? Are there specific criteria that indicate that the treatment is not effective? How long should the patient try the intervention before it is considered a failure?
For most people, GERD symptoms, particularly heartburn, should resolve within a few days of beginning medication. If symptoms don’t improve, first make certain the patient is taking the drug correctly, and then it may be time to reconsider your diagnosis.

Keep in mind, however, that other symptoms that accompany GERD, such as sore throat, hoarseness, cough or asthma, may take two to three months to respond to treatment. Don’t expect them to resolve right away.


Can you please discuss alternative therapies or treatments that may be available to GERD patients who are not responding to traditional therapies and the pros and cons of those interventions?

When it comes to patients whose heartburn resolves with medication, but are still experiencing regurgitation, it may be helpful to consider surgical treatments to tighten the esophageal sphincter. These procedures are also effective in patients who are responding well to medication but don’t want to remain on the medicine long term.


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What are some common scenarios that you encounter in your practice involving patients that don’t respond to GERD interventions?

The most common cases we see here are referrals from ear, nose, and throat specialists, who suspect GERD because the patient has a sore throat with redness. The problem is that many of these cases don’t turn out to be GERD. It’s like saying every time someone has a bump on their head it’s because somebody hit them with a baseball bat. Often the redness and the sore throat are due to allergies or sinusitis, which is why treatment for GERD would fail.

Overwhelmingly, when GERD symptoms don’t respond to treatment, it’s time to reconsider your diagnosis.

RESOURCES
Resources American Family Physician. Gastroesophageal Reflux Disease: Diagnosis and Management.  http://www.aafp.org/afp/1999/0301/p1161.html. Accessed on Aug. 4, 2012.