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.

Department of Gastroenterology Otto von Guericke Universität Magdeburg Germany

Department of Gastroenterology St Claraspital Basel Switzerland

Department of HepatoGastroenterology IKEM Prague Czech Republic

Department of Medicine and Therapeutics Chinese University of Hong Kong Sha Tin Hong Kong

Department of Surgery Stanford University Stanford California

Department of Surgery University of Hawaii Manoa Hawaii

Department of Surgery University of Washington Seattle Washington

Department of Surgical Oncological and Gastroenterological Sciences University of Padua Padua Italy

Department of Translational Research University of Pisa Pisa Italy

Division of Digestive and Liver Diseases Columbia University Medical Center New York New York

Division of Gastroenterology Hepatology and Endoscopy Brigham and Women's Hospital Boston Massachusetts

Division of Gastroenterology Johns Hopkins University Baltimore Maryland

Division of Gastroenterology Stanford University Stanford California

Division of Gastroenterology University of Alberta Edmonton Alberta Canada

Division of Gastroenterology Washington University School of Medicine St Louis Missouri

Gastroenterology Division Palo Alto Medical Foundation Mountain View California

Institute of Surgical Gastroenterology Madras Medical College Chennai Tamil Nadu India

Università degli Studi and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

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