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      Nonerosive Reflux Disease (NERD) - An Update

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          Abstract

          Recognizing nonerosive reflux disease (NERD) as a distinct presentation of gastroesophageal reflux disease (GERD) was one of the most important developments in the field of GERD in the last decade. Whilst the definition of NERD has not changed significantly over the years, the disorder accounts for the majority of the GERD patients and those who failed proton pump inhibitor (PPI) treatment. Recent developments in NERD focused primarily on understanding the pathophysiology and natural history. The introduction of esophageal impedance + pH has led to the assessment of other forms of gastroesophageal reflux in causing NERD. Therapeutic modalities still focus on acid suppression, but there is growing recognition that other therapeutic strategies should be considered in NERD.

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          Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications.

          Howard Hampel, Neena Abraham, Hashem El-Serag (2005)
          The association of body mass index and gastroesophageal reflux disease (GERD), including its complications (esophagitis, Barrett esophagus, and esophageal adenocarcinoma), is unclear. To conduct a systematic review and meta-analysis to estimate the magnitude and determinants of an association between obesity and GERD symptoms, erosive esophagitis, Barrett esophagus, and adenocarcinoma of the esophagus and of the gastric cardia. MEDLINE search between 1966 and October 2004 for published full studies. Studies that provided risk estimates and met criteria on defining exposure and reporting outcomes and sample size. Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were pooled by using a random-effects model. Nine studies examined the association of body mass index (BMI) with GERD symptoms. Six of these studies found statistically significant associations. Six of 7 studies found significant associations of BMI with erosive esophagitis, 6 of 7 found significant associations with esophageal adenocarcinoma, and 4 of 6 found significant associations with gastric cardia adenocarcinoma. In data from 8 studies, there was a trend toward a dose-response relationship with an increase in the pooled adjusted odds ratios for GERD symptoms of 1.43 (95% CI, 1.158 to 1.774) for BMI of 25 kg/m2 to 30 kg/m2 and 1.94 (CI, 1.468 to 2.566) for BMI greater than 30 kg/m2. Similarly, the pooled adjusted odds ratios for esophageal adenocarcinoma for BMI of 25 kg/m2 to 30 kg/m2 and BMI greater than 30 kg/m2 were 1.52 (CI, 1.147 to 2.009) and 2.78 (CI, 1.850 to 4.164), respectively. Heterogeneity in the findings was present, although it was mostly in the magnitude of statistically significant positive associations. No studies in this review examined the association between Barrett esophagus and obesity. Obesity is associated with a statistically significant increase in the risk for GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight.
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            The neurobiology of stress and gastrointestinal disease.

            E Mayer (2000)
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              Effectiveness of proton pump inhibitors in nonerosive reflux disease.

              Joshua Ofman, Kevin Knight, Ronnie Fass … (2004)
              Little information is available about the efficacy of proton pump inhibitors (PPIs) in patients with nonerosive reflux disease (NERD). We aimed to synthesize available data and determine the effectiveness of PPIs on symptom resolution in patients with NERD. A systematic review of the literature identified studies reporting the effects of PPIs in patients with NERD. Heartburn resolution data were pooled across studies. The effectiveness of PPI therapy in inducing complete heartburn resolution was compared in patients with NERD vs. erosive esophagitis (EE). Seven trials evaluating heartburn resolution in NERD were identified. Higher proportions of patients reported achieving sufficient heartburn resolution compared with complete heartburn resolution. The effect of PPIs on sufficient heartburn resolution was observed sooner than was complete heartburn resolution. Therapeutic gain of PPI therapy over placebo ranged from 30% to 35% for sufficient heartburn control and from 25% to 30% for complete heartburn control. Pooled response rates at 4 weeks were significantly higher for patients with EE compared with NERD (56% vs. 37%, P < 0.0001). PPIs provide a more modest therapeutic gain in patients with NERD as compared with those with EE. A trend in increased therapeutic gain for NERD patients was shown throughout the 4 weeks, suggesting that 4 weeks of follow-up evaluation may be insufficient to show full therapeutic gain in this patient population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Neurogastroenterol Motil
                Journal ID (publisher-id): JNM
                Title: Journal of Neurogastroenterology and Motility
                Publisher: Korean Society of Neurogastroenterology and Motility
                ISSN (Print): 2093-0879
                ISSN (Electronic): 2093-0887
                Publication date (Print): January 2010
                Publication date (Electronic): 31 January 2010
                Volume: 16
                Issue: 1
                Pages: 8-21
                Affiliations
                The Neuroenteric Clinical Research Group, Section of Gastroenterology, Southern Arizona VA Health Care System, Tucson, Arizona, USA.
                Author notes
                Correspondence: Ronnie Fass, M.D., FACP, FACG. Chief of Gastroenterology, Southern Arizona VA Health Care System, GI Section (1-111G-1), 3601 S. 6th Avenue, Tucson, AZ 85723-0001, USA. Tel: +1-520-792-1450 (ext. 5139), Fax: +1-520-629-4737, Ronnie.Fass@ 123456va.gov
                Article
                DOI: 10.5056/jnm.2010.16.1.8
                PMC ID: 2879816
                PubMed ID: 20535321
                SO-VID: 41de5927-7d6b-4588-bf2c-2969c5be7e2e
                Copyright © Copyright © 2010 Korean Society of Neurogastroenterology and Motility
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 December 2009
                Date accepted : 30 December 2009
                Categories
                Subject: Review

                ScienceOpen disciplines: Neurology
                Keywords: proton pump inhibitor,gastroesophageal reflux disease,nonerosive reflux disease
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: proton pump inhibitor, gastroesophageal reflux disease, nonerosive reflux disease

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