Summary: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Patients with proton pump inhibitor-refractory gastroesophageal reflux disease symptoms account for approximately 40% and represent a very common problem in clinical practice. The ESNM/ANMS consensus paper describes definitions regarding refractory GERD and refractory reflux-like symptoms. Additionally, it analyzes the pathophysiology and risk factors for refractory GERD. It also discusses the management of refractory GERD, including lifestyle intervention, optimizing acid-suppressive therapy and adjunctive medical therapy such as mucosal protection, Esoxx and alginates.