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Nonerosive reflux disease: clinical concepts

CP. Gyawali, DE. Azagury, WW. Chan, SM. Chandramohan, JO. Clarke, N. de Bortoli, E. Figueredo, M. Fox, D. Jodorkovsky, A. Lazarescu, P. Malfertheiner, J. Martinek, KM. Murayama, R. Penagini, E. Savarino, KP. Shetler, E. Stein, RP. Tatum, J. Wu,

. 2018 ; 1434 (1) : 290-303. [pub] 20180515

Language English Country United States

Document type Journal Article, Review

Persistent link   https://www.medvik.cz/link/bmc19035246

Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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$a Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.
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$a Azagury, Dan E $u Department of Surgery, Stanford University, Stanford, California.
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$a Chan, Walter W $u Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.
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$a Chandramohan, Servarayan M $u Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
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$a Clarke, John O $u Division of Gastroenterology, Stanford University, Stanford, California.
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$a de Bortoli, Nicola $u Department of Translational Research, University of Pisa, Pisa, Italy.
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$a Figueredo, Edgar $u Department of Surgery, University of Washington, Seattle, Washington.
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$a Lazarescu, Adriana $u Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
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$a Malfertheiner, Peter $u Department of Gastroenterology, Otto-von-Guericke Universität, Magdeburg, Germany.
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$a Murayama, Kenric M $u Department of Surgery, University of Hawaii, Manoa, Hawaii.
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$a Penagini, Roberto $u Università degli Studi and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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$a Savarino, Edoardo $u Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
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$a Shetler, Katerina P $u Gastroenterology Division, Palo Alto Medical Foundation, Mountain View, California.
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$a Stein, Ellen $u Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland.
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$a Tatum, Roger P $u Department of Surgery, University of Washington, Seattle, Washington.
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