Asymptomatic Erosive Esophagitis

Gastroesophageal reflux disease (GERD) is a very common condition characterized by chronic symptoms, such as heartburn or epigastric and/or substernal pain, that are frequently associated with mucosal damage resulting from abnormal reflux of gastric contents into the esophagus (Fass et al. in Nat Rev Dis Primers 7:55, 2021; Richter and Rubenstein in Gastroenterology 154:267-276, 2018). However, this damage can manifest in patients who do not exhibit typical GERD symptoms. Asymptomatic erosive esophagitis (AEE) is a condition in which there is esophageal mucosal injury typical for GERD, such as erosions, ulcerations, and/or Barrett's esophagus, visible in upper endoscopy, without concurrent symptoms attributable to GERD. AEE has been challenging to study, and it is not yet clear what causes this condition. As a result, there are no definitive guidelines on how to manage it. AEE also has the potential to be very impactful on public health, as those who are affected may go years without a diagnosis, putting them at risk for a variety of complications, including strictures and even cancer. Further careful study is necessary in order to more effectively address this condition. Here, we provide a comprehensive review of the scientific literature regarding AEE, examining its prevalence, clinical characteristics, potential causes and contributing factors, as well as identifying avenues for better characterization and management of this patient population.