Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 7: My Patient Has Dysphonia That I Believe Is Due To Reflux, But Her 24-Hour Ph Probe On Bid Pantoprazole Was Negative. Are There Other Reflux Tests That I Should Consider? (continued)

Patients with symptoms suspected due to GERD who are refractory to antisecretory therapy fall into the following categories: (1) GERD is the correct diagnosis and the patient is suboptimally treated for acid reflux. This is a patient with an extraesophageal or atypical symptom suspected due to GERD. In this case antisecretory therapy can be optimized in the short or long term and/or the patient offered endoscopic or antireflux surgery. (2) The patient has non-acid reflux. Early impedance/pH studies suggest this is seen in a small but important minority, most often with typical symptoms of…