Spechler SJ, Hunter JG, Jones KM, et al. - Individuals who were referred to Veterans Affairs (VA) gastroenterology clinics for proton-pump inhibitor (PPI)-refractory heartburn received 20 mg of omeprazole twice daily for 2 weeks, and those with tenacious heartburn underwent endoscopy, esophageal biopsy, esophageal manometry, and multichannel intraluminal impedance-pH monitoring in order to compare between the medical and surgical treatment for refractory heartburn. A total of 366 individuals (280 men) were recruited. Systematic workup exhibited accurately PPI-refractory and reflux-related heartburn in a minority of individuals among patients referred to VA gastroenterology clinics for PPI-refractory heartburn. For that highly chosen subgroup, surgery was better than medical treatment.