Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies

Aliment Pharmacol Ther. 2010 Sep;32(6):720-37. doi: 10.1111/j.1365-2036.2010.04406.x.


Background: Persistent gastro-oesophageal reflux disease (GERD) symptoms can occur despite proton pump inhibitor (PPI) therapy.

Aim: To assess the prevalence and potential determinants of persistent GERD symptoms in primary care and community-based studies.

Methods: Studies were identified by systematic PubMed and Embase searches; pooled prevalence data are shown as sample-size weighted means and 95% confidence intervals.

Results: Nineteen studies in individuals with GERD taking a PPI were included. In interventional, nonrandomized primary care trials, the prevalence of persistent troublesome heartburn and regurgitation was 17% (6-28%) and 28% (26-30%) respectively; in randomized trials, it was 32% (25-39%) and 28% (26-30%), respectively. In observational primary care and community-based studies, 45% (30-60%) of participants reported persistent GERD symptoms. Overall, persistent GERD symptoms despite PPI treatment were more likely in studies with a higher proportion of female participants [>60% vs. <50%, risk ratio (RR): 3.66; P < 0.001], but less likely in studies from Europe than in those from the USA (RR: 0.71; P < 0.001), and were associated with decreased psychological and physical well-being.

Conclusions: Persistent GERD symptoms despite PPI treatment are common in the primary care and community setting. Alternative approaches to management are required.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Clinical Trials as Topic
  • Community Health Services
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / physiopathology
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Primary Health Care
  • Proton Pump Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Gastrointestinal Agents
  • Proton Pump Inhibitors