Current Advances in the Diagnosis and Treatment of Nonerosive Reflux Disease
Open Access
- 11 July 2013
- journal article
- review article
- Published by Hindawi Limited in Gastroenterology Research and Practice
- Vol. 2013, 1-8
- https://doi.org/10.1155/2013/653989
Abstract
Nonerosive reflux disease (NERD) is a distinct pattern of gastroesophageal reflux disease (GERD). It is defined as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal mucosal erosions/breaks at conventional endoscopy. In clinical practice, patients with reflux symptoms and negative endoscopic findings are markedly heterogeneous. The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep), and sustained esophageal contractions. The use of 24-hour esophageal impedance and pH monitoring gives further insight into reflux characteristics and symptom association relevant to NERD. The treatment choice of NERD still relies on acid-suppression therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily) for 24 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily) is recommended. In patients with poor response to appropriate PPI treatment, 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid-reflux-related NERD (hypersensitive esophagus), nonacid-reflux-related NERD, and functional heartburn. The response is less effective in NERD as compared with erosive esophagitis.This publication has 79 references indexed in Scilit:
- Randomised clinical trial: a multicentre, double-blind, placebo-controlled study on the efficacy and safety of rabeprazole 5 mg or 10 mg once daily in patients with non-erosive reflux diseaseAlimentary Pharmacology & Therapeutics, 2010
- Nonerosive Reflux Disease (NERD) - An UpdateJournal of Neurogastroenterology and Motility, 2010
- Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus GroupDigestion, 2009
- Regional oesophageal sensitivity to acid and weakly acidic reflux in patients with non‐erosive reflux diseaseNeurogastroenterology & Motility, 2009
- The nonerosive reflux disease???gastroesophageal reflux disease controversyCurrent Opinion in Gastroenterology, 2008
- Asia‐Pacific consensus on the management of gastroesophageal reflux disease: UpdateJournal of Gastroenterology and Hepatology, 2007
- Overlap of gastro‐oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general populationAlimentary Pharmacology & Therapeutics, 2007
- Critical role of stress in increased oesophageal mucosa permeability and dilated intercellular spacesGut, 2007
- Lifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic TwinsGastroenterology, 2007
- Novel Measurement of Rapid Treatment Success with ReQuestTM: First and Sustained Symptom Relief as Outcome Parameters in Patients with Endoscopy-Negative GERD Receiving 20 mg Pantoprazole or 20 mg EsomeprazoleDigestion, 2005