The usual pattern is the development of solid food dysphagia first that progresses to include liquids. Back to Questions 2. The use of medication as a tool for the diagnosis of uncomplicated GERD has become an accepted practice. The presence of dysphagia in this situation complicates the scenario. This patient had no relief from all forms of antacid therapy, so the suspicion arises that his complaints are not being caused by acid reflux.
Antacids neutralize some portion of the gastric acid but they work for only a brief period of time.
PPI therapy may produce a limited response in some patients. There have been a few case reports of patients resistant to treatment with PPIs, but these individuals responded appropriately to H 2 RA administration. Patients with Zollinger-Ellison syndrome often require high doses of PPIs, but one would expect at least modest improvement of symptoms with antisecretory therapy. Most importantly, patients who do not respond at all to antacid therapy for GERD should never be referred for anti-reflux surgery without a complete evaluation and documented evidence of reflux disease. Back to Questions 3.