Non-erosive and erosive gastroesophageal reflux diseases: No difference with regard to reflux pattern and motility abnormalities

Martínek, Jan; Benes, Marek; Hucl, Tomáš; Drastich, Pavel; Stirand, Petr; Špičák, Julius

doi:10.1080/00365520801908928

Cited by 27 publications

(23 citation statements)

References 20 publications

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“…No difference was found between NERD and mild to moderate ERD in terms of acid exposure time and esophageal motor abnormalities [71]. Moreover, there was general agreement that there was no consistent evidence for abnormalities of gastric emptying, of salivary secretions or esophageal mucosal secretions in the pathogenesis of NERD.…”

Section: Pathobiological Mechanismsmentioning

confidence: 91%

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Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

et al. 2009

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Background/Aims: Although considerable information exists regarding gastroesophageal reflux disease with erosions, much less is known of non-erosive reflux disease (NERD), the dominant form of reflux disease in the developed world. Methods: An expert international group using the modified Delphi technique examined the quality of evidence and established levels of agreement relating to different aspects of NERD. Discussion focused on clinical presentation, assessment of clinical outcome, pathobiological mechanisms, and clinical strategies for diagnosis and management. Results: Consensus was reached on 85 specific statements. NERD was defined as a condition with reflux symptoms in the absence of mucosal lesions or breaks detected by conventional endoscopy, and without prior effective acid-suppressive therapy. Evidence supporting this diagnosis included: responsiveness to acid suppression therapy, abnormal reflux monitoring or the identification of specific novel endoscopic and histological findings. Functional heartburn was considered a separate entity not related to acid reflux. Proton pump inhibitors are the definitive therapy for NERD, with efficacy best evaluated by validated quality-of-life instruments. Adjunctive antacids or H₂ receptor antagonists are ineffective, surgery seldom indicated. Conclusions: Little is known of the pathobiology of NERD. Further elucidation of the mechanisms of mucosal and visceral hypersensitivity is required to improve NERD management.

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Section: Pathobiological Mechanismsmentioning

confidence: 91%

“…One recent study suggested that a small (<3 cm) hiatus hernia may contribute to the development of NERD, whereas an axial length of >3 cm was associated with a more severe disease [84], and in another study of patients with NERD and ERD hiatus hernia was found in 44 and 56%, respectively (not significantly different) [71]. …”

Section: Pathobiological Mechanismsmentioning

confidence: 99%

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

et al. 2009

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“…A tendency for NERD+ patients to have a higher mean LES pressure than ERD patients has also been reported in other studies, although the difference failed to reach statistical significance [14,20] . Findings for esophageal body motility did not differ significantly between patients with NERD+ and those with ERD, apart from a slight tendency for the distal wave amplitude to be greater in the first group.…”

Section: Physiopathological Patternmentioning

confidence: 68%

“…Hiatal hernia is currently assumed to be one of the physiopathological factors contributing to the onset of GERD by reducing LES competence and interfering with esophageal clearance [17,18] . Hiatal hernia is apparently a dominant predictor of erosive esophagitis [19] but it has been little studied in patients with NERD who are less likely to have hiatal hernias than patients with esophagitis [14,5,20] .…”

Section: General Considerations: Study Populationmentioning

confidence: 99%

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Bresàdola¹

2011

WJGP

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AIM: To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 h pH monitoring. METHODS:For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the reflux symptoms, manometric characteristics of the lower esophageal sphincter (LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study, patients had to have NERD or ERD and be found positive on pH monitoring (NERD+). Patients with Gastroesophageal reflux disease (GERD) complicated by stenosis, ulcers or Barrett's esophagus were ruled out.RESULTS: 214 patients were involved in the study, i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender-or age-related differences between the two groups. The ERD group had more cases of hiatal hernia (P = 0.02) and more acid reflux, both in terms of number of reflux episodes (P = 0.01) and as a percentage of the total time with a pH < 4 (P = 0.00), when upright (P = 0.007) and supine (P = 0.00). The NERD+ cases had more reflux episodes while upright (P = 0.02) and the ERD cases while supine (P = 0.01). The LES pressure was higher in cases of NERD+ (P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group (P >0.05). The NERD+ patients presented more often with atypical symptoms (P = 0.01). CONCLUSION:The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position (unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.

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“…Ghosh et al (2008) reported that weak mid esophageal contractions at the proximal smooth-muscle segment appear to be the cause of impaired clearance function. Martinek et al (2008) reported no difference between NERD and mild to moderate erosive esophagitis in terms of motor abnormalities. However, this study was performed using conventional monometry.…”

Section: Discussionmentioning

confidence: 99%

Combined pH-impedance monitoring and high-resolution manometry of Japanese patients treated with proton-pump inhibitors for persistent symptoms of non-erosive reflux disease

Yamashita

Ashida

Fukuchi

et al. 2012

J. Smooth Muscle Res.

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Background: Data on acid and non-acid reflux patterns and esophageal function in Japanese patients with non-erosive reflux disease (NERD) are limited. The aim of this study was to use combined multichannel intraluminal impedance pH monitoring (MII-pH) and high-resolution manometry (HRM) to investigate the characteristics of Japanese patients who were treated with a "double-dose" (20 mg) of rabeprazol (a proton-pump inhibitor; PPI) for persistent symptoms of NERD. Methods: Twenty-five patients who complained of typical gastroesophageal reflux disease symptoms, which had occurred more than twice a week despite treatment with rabeprazol, were enrolled in the study. All patients underwent upper endoscopy, esophageal HRM, and 24-h MII-pH monitoring while double-dose PPI therapy was continued. Results: Twelve (48.0%) of the patients had a positive symptom index (SI) with 234 recorded symptoms, 127 (54.3%) of which were related to reflux episodes. Of those with reflux episodes, 29 (22.8%) were related to acid reflux, while 98 (77.2%) were the result of a weaker acidic reflux. In acid reflux and in mixed (liquid-gas) reflux, the proximal esophageal region was involved to a significantly greater degree (P<0.002 and P=0.005, respectively) than the distal region. In liquid reflux, there was no difference between the distal and proximal regions. HRM showed that proximal motility parameters were significantly more defective than in those of healthy volunteers. Conclusions: MII-pH monitoring indicated that weakly acidic reflux and mixed refluxate in the proximal esophagus is the major cause of persistent symptoms in patients with NERD who are being treated with PPI. HRM showed that proximal esophageal dysfunction might be a key condition that facilitates reflux.

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Non-erosive and erosive gastroesophageal reflux diseases: No difference with regard to reflux pattern and motility abnormalities

Cited by 27 publications

References 20 publications

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Combined pH-impedance monitoring and high-resolution manometry of Japanese patients treated with proton-pump inhibitors for persistent symptoms of non-erosive reflux disease

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