The first is to perform 24-hour pH testing to determine whether the
PPI is ineffective or if a disease other than GERD is likely to be present. If the
PPI is ineffective, a higher dose of PPI may be tried. The second option is to go ahead without 24 hour pH testing and to increase the dose of PPI. Another alternative is to add another drug to the PPI that works in a way that is different from the PPI, for example, a pro-motility drug or a foam barrier.