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Nonerosive Reflux Disease (NERD)

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Gastrointestinal Motility Disorders

Abstract

Nonerosive reflux disease (NERD) is defined by typical gastroesophageal reflux-related symptoms, lack of endoscopic evidence of esophageal inflammation, and increased esophageal acid exposure. NERD is the most common phenotypic presentation of gastroesophageal reflux disease (GERD), accounting for up to 70% of all patients with heartburn symptoms. NERD also accounts for the majority of the GERD patients who failed proton pump inhibitor (PPI) treatment. There is a very low, if any, rate of progression from NERD to erosive esophagitis and Barrett’s esophagus. After initial normal endoscopic evaluation, pH testing is pivotal to the diagnosis of NERD and to distinguish the disorder from functional heartburn and reflux hypersensitivity. While not yet in clinical practice, mucosal impedance is a diagnostic tool that has been shown to be useful in diagnosing NERD patients including those who are refractory to PPI therapy already during endoscopy. Treatment focuses on acid suppression, but the proportion of NERD patients responding to a standard dose of PPI is significantly lower than what has been documented in patients with erosive esophagitis. Endoscopic therapy and antireflux surgery have been demonstrated to be efficacious in carefully selected NERD patients. Alternative therapeutic strategies consist of transient lower esophageal sphincter relaxation reducers, pain modulators, psychological intervention, acupuncture, and other alternative and complementary medicine approaches.

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Abdallah, J., Fass, R. (2018). Nonerosive Reflux Disease (NERD). In: Bardan, E., Shaker, R. (eds) Gastrointestinal Motility Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-59352-4_10

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