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

Summary 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.