ESOPHAGUS: Edited by Stuart J. SpechlerManagement of regurgitation in patients with gastroesophageal reflux diseaseBell, Reginald C.W.Author Information Institute of Esophageal and Reflux Surgery, Englewood, Colorado, USA Correspondence to Reginald C.W. Bell, MD, Institute of Esophageal and Reflux Surgery, 499 E Hampden Ave., Suite 400, Englewood, CO 80113, USA. Tel: +1 303 788 7700; fax: +1 303 788 9892; e-mail: firstname.lastname@example.org Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-gastroenterology.com). Current Opinion in Gastroenterology: July 2020 - Volume 36 - Issue 4 - p 336-343 doi: 10.1097/MOG.0000000000000649 Buy SDC Metrics Abstract Purpose of review Precision treatment of medically-refractory regurgitation differs from that of heartburn. Regurgitation is an often-overlooked symptom characterized as a bitter taste in the mouth or a sense of fluid moving up from the stomach occurring in approximately 80% of gastroesophageal reflux disease (GERD) patients with varying severity. Its response to standard medical therapy is significantly less than heartburn while significantly lessening quality of life in 10–20% of GERD patients. Recent findings The therapeutic gain of proton pump inhibitors (PPIs) above placebo averages 17% for regurgitation compared with 41% for heartburn. Increased dosing of medication is commonly, yet futilely, used. The symptom is probably mediated more by fluid volume than by the acidity of the refluxate. PPIs significantly decrease gastric acid secretion and to some extent volume of gastric juice. Significantly, doubling the PPI dose does not incrementally decrease gastric juice volume though it may decrease gastric acid secretion further. Studies on refractory regurgitation using some of the newer antireflux procedures (magnetic sphincter augmentation and transoral fundoplication) demonstrated success in over 85% of patients whereas increased PPI dosing helped in approximately 15%. Summary Precision care of regurgitation should recognize the low-therapeutic impact of acid control, while antireflux procedures are very successful. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.