Most patients with heartburn from GERD respond nicely to the Proton Pump Inhibitors, such as Prilosec, Protonix, Prevacid, Nexium, and others. Frazzoni in the American Journal of Gastroenterology May 2018 studied those whose symptoms were not relieved by these medications. Many of these patients were found to have poor clearance of acid from the esophagus. In other words, when the acid would reflux up into the esophagus, it was poorly propelled back down into the stomach. The treatment for this problem will require a different approach than the usual acid suppression.