Untangling Nonerosive Reflux Disease From Functional Heartburn

Area of Science:

• Gastroenterology
• Esophageal Disorders
• Functional GI Disorders

Background:

• Heartburn is a frequent clinical complaint, yet up to 70% of patients exhibit normal upper endoscopy results.
• These patients often have nonerosive reflux disease (NERD) or functional esophageal disorders.
• NERD is the predominant phenotype of gastroesophageal reflux disease, while functional heartburn is the leading cause of refractory heartburn.

Purpose of the Study:

• To differentiate between NERD and functional heartburn based on underlying mechanisms and diagnostic requirements.
• To outline the distinct treatment strategies for NERD and functional heartburn.

Main Methods:

• Review of diagnostic criteria for NERD and functional heartburn.
• Comparison of diagnostic procedures including upper endoscopy, reflux testing, and esophageal manometry.
• Analysis of treatment modalities for both conditions.

Main Results:

• NERD involves gastroesophageal reflux and esophageal hypersensitivity; functional heartburn involves only esophageal hypersensitivity.
• Diagnosis of NERD requires endoscopy and reflux testing.
• Diagnosis of functional heartburn requires endoscopy, reflux testing, and esophageal manometry.
• NERD is primarily managed with medical, endoscopic, or surgical antireflux treatments.
• Both NERD and functional heartburn can be treated with neuromodulators, psychological interventions, and complementary medicine.

Conclusions:

• Accurate diagnosis distinguishing NERD from functional heartburn is crucial for targeted therapy.
• A range of treatment options exist, from conventional antireflux approaches to neuromodulators and complementary therapies.