{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:37:34Z","timestamp":1773247054718,"version":"3.50.1"},"reference-count":60,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2006,1,1]],"date-time":"2006-01-01T00:00:00Z","timestamp":1136073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2006,1,1]],"date-time":"2006-01-01T00:00:00Z","timestamp":1136073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"published-print":{"date-parts":[[2006]]},"abstract":"<jats:p>Patients with refractory heartburn to proton pump inhibitors (PPIs) represent a distinctive group which is difficult to manage. In a systematic review of the relative literature we found that approximately 20% of patients with erosive esophagitis and 15\u201325% of patients with normal endoscopy and abnormal 24-hour esophageal pH monitoring continue to report heartburn despite treatment with standard dose PPIs. Furthermore, approximately 30\u201340% of patients with normal endoscopy and 24-hour pH studies and 15\u201320% of patients with Barrett\u2019s esophagus have refractory heartburn to double dose PPIs. In such cases, compliance to therapy, duodeno-gastroesophageal reflux, gastro-esophageal motility disorders and eradication of &lt;i&gt;Helicobacter pylori&lt;\/i&gt; infection may contribute to symptoms. Based on the available evidence, we suggested an algorithm for the evaluation and management of these patients.<\/jats:p>","DOI":"10.1159\/000094789","type":"journal-article","created":{"date-parts":[[2006,8,2]],"date-time":"2006-08-02T19:25:17Z","timestamp":1154546717000},"page":"218-227","source":"Crossref","is-referenced-by-count":16,"title":["Refractory Heartburn to Proton Pump Inhibitors: Epidemiology, Etiology and Management"],"prefix":"10.1159","volume":"73","author":[{"given":"Spiros N.","family":"Sgouros","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apostolos","family":"Mantides","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2006,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1080%2F003655298750026697"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2005.41217.x"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.1999.01206.x"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2005.40945.x"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016%2FS1542-3565%2805%2900860-8"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2000.00882.x"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2003.07665.x"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016%2FS1542-3565%2804%2900288-5"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3109%2F00365529709011212"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1080%2F00365529850166149"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1001%2Farchinte.159.18.2161"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2003.01423.x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.51.6.885"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1053%2Fj.gastro.2004.08.014"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2000.03254.x"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016%2FS0002-9270%2801%2904094-1"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2001.00904.x"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1365-2036.2004.02162.x"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.1998.211_a.x"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1053%2Fgast.1999.0029900327"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2000.00749.x"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016%2FS0016-5107%2896%2970055-X"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.1998.00426.x"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016%2FS1091-255X%2801%2980046-9"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2004.04171.x"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1097%2F00042737-200602000-00015"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1365-2036.2006.02843.x"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1055%2Fs-2006-924983"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1053%2Fgast.2001.24840"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1053%2Fgast.2003.50043"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.36.4.539"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.2005.066464"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016%2FS0016-5085%2899%2970544-5"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.1998.221_a.x"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.1999.00641.x"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2003.01594.x"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2002.t01-1-01281.x"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1053%2Fgast.2002.31876"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1016%2FS0009-9236%2896%2990196-4"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1067%2Fmcp.2002.127637"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2003.01539.x"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2003.01645.x"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1053%2Fgast.1996.1101982"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1007%2FBF01535789"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.37.4.457"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1007%2FBF02065545"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2005.41184.x"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1080%2F003655202753387275"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2003.07398.x"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1572-0241.2005.41719.x"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.2005.064691"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.2005.066274"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1136%2Fgut.52.10.1397"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1046%2Fj.1365-2036.2000.00854.x"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1111%2Fj.1365-2036.2006.02772.x"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1067%2Fmhj.2000.108514"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1023%2FA%3A1026645914933"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1016%2FS0016-5107%2803%2902027-3"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1067%2Fmge.2001.112843"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1067%2Fmge.2001.113912"}],"container-title":["Digestion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/94789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/94789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T02:35:23Z","timestamp":1745462123000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000094789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006]]},"references-count":60,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2006,9,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000094789","archive":["Portico"],"relation":{},"ISSN":["0012-2823","1421-9867"],"issn-type":[{"value":"0012-2823","type":"print"},{"value":"1421-9867","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006]]}}}