Esophageal reflux hypersensitivity: Non-GERD or still GERD?

Area of Science:

• Gastroenterology
• Esophageal Disorders
• Functional Gastrointestinal Disorders

Background:

• The Rome IV classification modified definitions for functional esophageal disorders, notably reclassifying non-erosive reflux disease (NERD) and reflux hypersensitivity.
• This classification separated patients with normal acid exposure and symptoms into functional heartburn or reflux hypersensitivity, distinct from gastroesophageal reflux disease (GERD).

Purpose of the Study:

• To review current knowledge on non-erosive reflux disease (NERD) and reflux hypersensitivity.
• To discuss the implications of the Rome IV criteria for identifying and managing functional esophageal disorders, particularly concerning reflux hypersensitivity's place within the GERD spectrum.

Main Methods:

• Literature review of recent pathophysiological and therapeutic data concerning reflux hypersensitivity and NERD.
• Analysis of the Rome IV classification criteria in light of emerging evidence.

Main Results:

• Recent data suggest physiological alterations in esophageal mucosal integrity and chemical clearance in reflux hypersensitivity support its inclusion in the GERD spectrum.
• Surgical anti-reflux therapy shows positive outcomes in reflux hypersensitivity, unlike functional heartburn.
• Clinical trial data for neuromodulators in these conditions are limited and conflicting.

Conclusions:

• The Rome IV classification's exclusion of reflux hypersensitivity from GERD is debatable.
• Reflux hypersensitivity likely represents a distinct entity within the GERD spectrum, requiring specific diagnostic and therapeutic considerations.
• Re-evaluation of the Rome IV criteria may be necessary for accurate patient management.