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However, the frequency of residual symptom reporting on proton pump inhibitor (PPI) therapy suggests the two entities have some differential pathophysiological determinants requiring distinct management approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To examine the complexities of reflux\u2010like symptom pathophysiology and strategies that may be used to target contributing factors beyond acid reflux.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A panel of ten expert clinicians (primary care, gastroenterology and psychology) held a series of online meetings to share perspectives on the underlying contributors to, and management of, reflux\u2010like symptoms when PPIs are ineffective or provide partial relief. This review summarises the agreed key themes that emerged from the expert discussions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>While degradation of the anti\u2010reflux barrier dominates in reflux oesophagitis, cognitive\u2010affective, behavioural, and other psychosocial factors can play a major role in symptom persistence. These require individualised management strategies, beginning with education on the gut\u2010brain connection and expectation setting with regard to PPI therapy. A detailed clinical history and patient\u2010reported outcome tools that measure symptom burden and associated anxiety\/hypervigilance can help guide management using brain\u2010gut behavioural therapies, supported diet\/lifestyle modification, diaphragmatic breathing, weight loss, and\/or on\u2010demand symptom control measures according to a patient's specific needs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A paradigm shift in reflux\u2010like symptom management is required such that acid suppression is viewed as one of several interventions that can be utilised as part of a phenotype\u2010driven, individualised approach to care that acknowledges the multiple contributors to symptom burden.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.70115","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T09:33:22Z","timestamp":1743586402000},"page":"1437-1446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Review Article: Individualised Management of Reflux\u2010Like Symptoms\u2014Strategies Beyond Acid Suppression"],"prefix":"10.1111","volume":"61","author":[{"given":"Peter J.","family":"Kahrilas","sequence":"first","affiliation":[{"name":"Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie","family":"Keefer","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai  New York New York State USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena","family":"Yadlapati","sequence":"additional","affiliation":[{"name":"University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foteini","family":"Anastasiou","sequence":"additional","affiliation":[{"name":"4th Local Health Team (TOMY), Municipality Practice, Academic Practice of Heraklion  Heraklion Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel J.","family":"Heidelbaugh","sequence":"additional","affiliation":[{"name":"Department of Family Medicine University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin W.","family":"Howden","sequence":"additional","affiliation":[{"name":"University of Tennessee College of Medicine  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan M.","family":"Mendive","sequence":"additional","affiliation":[{"name":"La Mina Primary Health Care Academic Centre, Catalan Institute of Health (ICS), University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology University of Padova  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Udrescu","sequence":"additional","affiliation":[{"name":"Individual Family Practice  Bucharest Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-8927","authenticated-orcid":false,"given":"A. 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