PMID- 17557041
OWN - NLM
STAT- MEDLINE
DCOM- 20071012
LR  - 20131121
IS  - 1121-421X (Print)
IS  - 1121-421X (Linking)
VI  - 53
IP  - 2
DP  - 2007 Jun
TI  - Nonerosive reflux disease.
PG  - 127-41
AB  - Nonerosive reflux disease (NERD) is the most common phenotype of gastroesophageal 
      reflux disease. By definition, patients with NERD have typical reflux symptoms 
      caused by the intraesophageal reflux of gastric contents but have no visible 
      esophageal mucosal injury. This is in contrast to patients with erosive reflux 
      disease (ERD) or Barrett's esophagus (BE) who have obvious esophageal mucosal 
      injury on endosco-py. Only 50% of patients with NERD have pathologic esophageal 
      acid exposure as detected on 24-h pH monitoring. NERD patients with physiologic 
      esophageal acid exposure and good temporal correlation of symptoms with reflux 
      events are considered to have esophageal hypersensitivity, while patients with no 
      symptom-reflux correlation are considered to have functional heartburn. It is 
      possible yet uncommon for NERD to progress to severe ERD (i.e. LA Grade C or D) 
      or BE. Patients with NERD and pathologic esophageal acid exposure have motor 
      dysfunction and acid reflux abnormalities that are similar to patients with ERD 
      and BE, whereas NERD patients with physiologic esophageal acid exposure have 
      minimal abnormalities and are not much different than healthy controls. The 
      pathological feature most indicative of NERD is the presence of dilated 
      intercellular spaces within squamous epithelium, an ultrastructural abnormality 
      readily identified on transmission electron microscopy but also on light 
      microscopy. A symptomatic response to an empiric trial of high-dose proton pump 
      inhibitor (PPI) therapy is a simple and useful strategy to establish the 
      diagnosis of NERD, although histology and pH monitoring may be useful in 
      confirming the diagnosis. Patients with NERD suffer similar decrements in quality 
      of life as do patients with erosive esophagitis. Therapy is aimed at eliminating 
      or reducing symptoms and improving quality of life. PPIs are the most effective 
      agents for the treatment of NERD although they are less effective in providing 
      symptom relief than in patients with erosive esophagitis. Laparoscopic antireflux 
      surgery is an effective therapy for selected patients with NERD and outcomes are 
      better when performed in high volume centers.
FAU - Long, J D
AU  - Long JD
AD  - Section of Gastroenterology, Department of Medicine, Wake Forest University 
      School of Medicine, Winston-Salem, NC 27157, USA. jolong@wfubmc.edu
FAU - Orlando, R C
AU  - Orlando RC
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - Minerva Gastroenterol Dietol
JT  - Minerva gastroenterologica e dietologica
JID - 9109791
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Barrett Esophagus/diagnosis
MH  - Diagnosis, Differential
MH  - Epithelial Cells/pathology
MH  - Esophageal pH Monitoring
MH  - Esophagitis, Peptic/diagnosis
MH  - Esophagoscopy
MH  - Extracellular Space
MH  - Fundoplication
MH  - Gastroesophageal Reflux/*diagnosis/pathology/physiopathology/therapy
MH  - Humans
MH  - Proton Pump Inhibitors
MH  - Quality of Life
RF  - 94
EDAT- 2007/06/09 09:00
MHDA- 2007/10/13 09:00
CRDT- 2007/06/09 09:00
PHST- 2007/06/09 09:00 [pubmed]
PHST- 2007/10/13 09:00 [medline]
PHST- 2007/06/09 09:00 [entrez]
PST - ppublish
SO  - Minerva Gastroenterol Dietol. 2007 Jun;53(2):127-41.