| Theme |
GERD -- Recent Clinical Advances |
| Title |
Non-erosive Reflux Disease: Current Concepts and Clinical Implications |
| Author |
Yasuki Habu |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Hiroshi Hisatsune |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Noriko Kumamoto |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Akiko Kurishima |
Department of Gastroenterology, Saiseikai-Noe Hospital |
| Author |
Shigeto Mizuno |
Department of Medical Pharmaceutics, Kobe Pharmaceutical University |
| Author |
Keiichi Kawai |
Digestive Clinical Outcomes Research Group |
| [ Summary ] |
Non-erosive reflux disease(NERD) is defined as a condition which has troublesome reflux-related symptoms without evidence of erosive changes in the lower esophageal mucosa. Putative mechanisms for this disease include not only acid reflux, but also weak acid reflux, non-acid reflux, visceral hypersensitivity or exaggerated perception. In many cases, reflux testing is not available to practicing physicians. Therefore, the differentiation of true reflux disease from motility disorders or functional heartburn in all patients who have reflux-like symptoms without erosive changes in endoscopy is difficult. Acid suppressive therapy with proton pump inhibitors(PPIs) is the first line of treatment for both erosive and non-erosive reflux disease(NERD). However, patients with NERD are significantly less likely than patients with erosive disease to achieve symptomatic responses with PPIs. Therapeutic approaches for PPI failure remains an area of controversy. Pharmaco-therapy such as adding H-2 receptor antagonists at bedtime or the use of pain modulators including antidepressants might be considered. Antireflux surgery should be offered only to carefully selected patients with clear documentation of symptoms associated with reflux using pH monitoring or multichannel intraluminal impedance-pH(MII-pH) monitoring. |