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The steering committee developed specific PICO questions pertaining to the management of PPI rRLS. Methodologists conducted systematic reviews of the literature. The quality of evidence and strength of recommendations were rated using the GRADE approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Consensus was reached on 13 of 17 statements on diagnosis and management. For rRLS, suggested diagnostic strategies included endoscopy, ambulatory reflux testing and oesophageal manometry. The group did not reach consensus on the role of oesophageal biopsies or the use of reflux\u2010symptom association in patients undergoing reflux testing. The group suggested against increasing the PPI dose in patients who had received 8\u2009weeks of a twice\u2010daily PPI. Adjunctive alginate or antacid therapy was suggested. There was no consensus on the role of adjunctive prokinetics. There was little role for adjunctive transient lower oesophageal sphincter relaxation (TLESR) inhibitors or bile acid sequestrants. Endoscopic or surgical anti\u2010reflux procedures should not be performed in patients with rRLS in the absence of objectively confirmed GERD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The management of rRLS should be personalised, based on shared decision\u2010making regarding the role of diagnostic testing to confirm or rule out GERD as a basis for treatment optimisation. Anti\u2010reflux procedures should not be performed without objective confirmation of GERD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18420","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T14:38:29Z","timestamp":1735569509000},"page":"636-650","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Management of Patients With Refractory Reflux\u2010Like Symptoms Despite Proton Pump Inhibitor Therapy: Evidence\u2010Based Consensus Statements"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2487-1479","authenticated-orcid":false,"given":"David","family":"Armstrong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology &amp; Farncombe Family Digestive Health Research Institute McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-8927","authenticated-orcid":false,"given":"A. 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