I dont know either, I am on a PPI and am on a resticted diet and I still have some symptoms. Granted they are not as bad but still there. Dr. Koufman says that Pepsin can be activated below a PH of 5, so if you limit your intake of foods that are below a 5, pepsin should not be acitvated. This GERD stuff is really confusing. I am doing everything I am supposed to do and still have some symptoms. They come and go, and change.
Diagnosed GERD, no other medical conditions (this one is enough)