Nonerosive reflux disease: clinical concepts

Abstract

Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

Bile reflux in patients with nerd is associated with more severe heartburn and lower values of mean nocturnal baseline impedance and chemical clearance

“…Gastroesophageal reflux disease (GERD) is a chronic condition characterized by a heterogeneous spectrum of typical and atypical symptoms, of which heartburn is the most common symptom. 1,2 As proton-pump inhibitors (PPIs) are effective in improving GERD-related heartburn, response to empiric PPI therapy is used clinically to confirm GERD diagnosis in the absence of alarm symptoms, despite limited specificity due to overlap with functional esophageal disorders. [3][4][5] However, many patients respond only partially or do not respond to an 8-week course of full-dose PPI.…”

“…Gastroesophageal reflux disease (GERD) is a chronic condition characterized by a heterogeneous spectrum of typical and atypical symptoms, of which heartburn is the most common symptom 1,2 …”

The functional lumen imaging probe in gastrointestinal disorders: the past, present, and future

“…Like much of modern medicine, gastroesophageal reflux disease (GERD) is not a homogeneous disorder, but rather is caused by a myriad of mechanisms resulting in similar symptoms. Disparate mechanisms believed to play a role in disease burden include hiatal hernia (HH), increased transient lower esophageal sphincter (LES) relaxation, hypotensive LES, abnormal motility leading to impaired clearance, xerostomia, impaired swallowing, impaired gastric emptying, acid hypersecretion, mucosal disruption/permeability, and hypersensitivity 42–45 . An argument could be made that FLIP may play a role in the evaluation of EGJ distensibility and esophageal motility, both of which are believed to be key mechanisms in GERD; however, FLIP certainly does not test for all the proposed reflux mechanisms, nor is it an adequate test of mucosal integrity or acid burden.…”

Clinical Assessment of Gastrointestinal Involvement in Patients with Systemic Sclerosis

“…54 pH monitoring has been shown to be a useful subsequent study to diagnose non-erosive reflux disease in cases with normal mucosal findings on EGD. 36,55 A retrospective study of 10 SSc patients with reflux referred for lung transplant 56 found that abnormal pH was predictive for lower 1-year survival rates.…”