There is no uniform definition of refractory GERD, and it is generally accepted that symptoms such as heartburn and/or reflux do not improve significantly after 8-12 weeks of treatment with double-dose PPI. Clinically, it is found that some refractory GERD is actually not so difficult to treat. 1.Improvement of diet and lifestyle habits. the occurrence of GERD is closely related to diet and lifestyle habits, and if only medication is taken without attention, recurrent attacks will occur. 2, change a PPI treatment. At present, there are more types of PPI with different molecular structures, and some patients respond differently to different types of PPI. 3.Take a detailed medical history, and give appropriate treatment if accompanied by dyspepsia, anxiety, depression, etc. 4.Patients with combined alkaline reflux, add anti-cholestatic drugs.