The patient with GORD and chronically recurrent problems.

Treatment of gastro-oesophageal reflux disease (GORD) by means of gastric acid secretion inhibition usually is successful. When symptoms persist despite adequate treatment, correctness of the diagnosis of GORD should be questioned. Quite often dyspeptic symptoms are erroneously interpreted as GORD symptoms. Other causes of treatment failure are insufficient acid suppression and oesophageal hypersensitivity. In the management of patients with persistent symptoms oesophageal pH and impedance monitoring are useful techniques. These may provide answers to the question whether the symptoms are reflux-related and whether acid secretion is adequately suppressed.