Nonerosive reflux disease: clinical concepts

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Reflux Disease Management

Background:

• Gastroesophageal reflux disease (GERD) is common, but diagnosis is complex for nonerosive reflux disease (NERD) when symptoms persist despite treatment or endoscopy is normal.
• Esophageal symptoms can stem from various conditions, including GERD, mucosal/motor disorders, structural issues, and functional syndromes.

Purpose of the Study:

• To review the evaluation, diagnosis, differential diagnosis, and management of nonerosive reflux disease (NERD).
• To highlight the role of esophageal physiological tests in diagnosing NERD and guiding treatment.

Main Methods:

• Review of current literature on GERD, NERD, and esophageal diagnostic techniques.
• Discussion of ambulatory pH or pH-impedance monitoring and manometry for assessing reflux burden and symptom association.
• Analysis of therapeutic strategies including acid suppression, antireflux surgery, and adjunctive therapies.

Main Results:

• NERD diagnosis can be confirmed by abnormal reflux burden identified through ambulatory reflux monitoring.
• Patients with NERD diagnosed via monitoring show similar symptom response to antireflux therapy as those with erosive esophagitis.
• Acid suppression is the primary treatment, with surgery being a definitive option for persistent symptoms, particularly with esophagogastric junction compromise.

Conclusions:

• Esophageal physiological testing is crucial for diagnosing NERD and differentiating it from other esophageal disorders.
• Effective management of NERD involves acid suppression, with antireflux surgery as a key intervention for refractory cases.
• Adjunctive and complementary therapies may offer additional benefits in managing NERD symptoms.