Doctors are well aware that in roughly half the cases, PPIs don't bring relief for GERD. So in order to complicate the situation, and grope for a reason why the drugs don't work, they have decided that if PPIs don't work, the patient has NERD, not GERD.
Or, if they want to sound a little more professional, the can call it functional heartburn. 
And yet they continue to prescribe the PPIs as if they know what they are doing. 
Many doctors tell patients with NERD or functional heartburn to continue taking proton-pump inhibitors, despite studies showing they are less effective in such cases. The Food and Drug Administration has issued warnings that long-term use and high doses can increase the risk of bone fractures and bacterial infections—and may reduce the absorption of key nutrients, including magnesium, calcium and vitamin B12.
And GI specialists love to talk out of both sides of their mouth.
http://online.wsj.com/article/SB1000142 ... 78010.htmlMainstream gastroenterologists say there is little evidence that an inflammatory reaction causes heartburn. Then again, doctors have long counseled patients to avoid common "trigger" foods such as chocolate, peppermint, peppers, alcohol and caffeine.
Note that in the article, no doctor ever suggests that maybe the reason why PPIs don't work for so many people is because they don't have excess acid in the first place.
Tex
