Eli is a 16-year-old boy with longstanding chronic reflux.

For six months, he has had worsening nocturnal cough, sore throat, throat clearing, heartburn and regurgitation. He develops post-prandial vomiting if he overeats.

These have persisted despite increasing doses of PPI therapy. There is no history of lower respiratory tract infection or asthma. He denies early satiety, bloating or dysphagia. Eli was diagnosed with reflux as a neonate.

He was referred to a paediatric gastroenterologist and treated with antacids, histamine antagonists, PPIs and postural manoeuvres.