Q1. Correct answer: C
There are many potential reasons for PPI failure in patients with symptoms of gastroesophageal reflux. However, the single most important reason is inappropriate drug administration. Patients should be counseled to take their medication 30-60 minutes prior to meals for optimal physiologic gastric acid inhibition, with the morning meal favored over the evening meal due to relative more gastric acid production at this time.
Fass R, Shapiro M, Dekel R. Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease – where next? Aliment Pharmacol Ther. 2005;22:79-94.