All patients referred to the Veterans Affairs gastroenterology clinics for refractory heartburn were screened. Eligible patients would complete the gastro-oesophageal refl ux disease (GORD) – Health Related Quality of Life (GORD-HRQL) questionnaire followed by 2-week trial of omeprazole at a dose of 20 mg twice daily, after which the GORD-HRQL was repeated. Patients who did not show improvement (i.e. decrease of 50% in the initial GORD-HRQL score) then underwent endoscopy with biopsies from the lower oesophagus, but also oesophageal manometry and intraluminal impedance–pH monitoring while continuing omeprazole at the same dose and frequency. Patients with severe refl ux oesophagitis, non-GORD endoscopic abnormalities, oeosinophilic oesophagitis, achalasia or absent contractility were excluded. Other patient-reported outcomes included depression, anxiety and health function.
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