Abstract
Gastroesophageal reflux disease (GERD) is a common condition primarily treated with acid-suppressive therapies such as proton pump inhibitors (PPIs) or potassium competitive acid blockers (P-CABs). However, many patients experience a suboptimal response to PPIs or symptom recurrence upon discontinuation, leading to an increased economic burden and reduced quality of life. For patients unresponsive to PPIs, objective tests such as reflux monitoring are essential to differentiate GERD from other conditions or to understand the underlying mechanisms causing the reflux. Strategies like optimizing adherence, dose escalation, switching to other PPIs, or transitioning to P-CABs can improve treatment outcomes. Use of neuromodulators may benefit patients with functional heartburn or reflux hypersensitivity. For those requiring maintenance therapy, explaining the advantages and disadvantages of continuous versus on-demand treatment and providing clear guidance can help achieve effective symptom control with the minimal necessary dosage of the medication. Sequential maintenance therapy, which begins with daily medication and transitions to on-demand therapy, is effective in improving patient satisfaction while minimizing drug exposure.