Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group

Abstract

Background/Aims: Although considerable information exists regarding gastroesophageal reflux disease with erosions, much less is known of non-erosive reflux disease (NERD), the dominant form of reflux disease in the developed world. Methods: An expert international group using the modified Delphi technique examined the quality of evidence and established levels of agreement relating to different aspects of NERD. Discussion focused on clinical presentation, assessment of clinical outcome, pathobiological mechanisms, and clinical strategies for diagnosis and management. Results: Consensus was reached on 85 specific statements. NERD was defined as a condition with reflux symptoms in the absence of mucosal lesions or breaks detected by conventional endoscopy, and without prior effective acid-suppressive therapy. Evidence supporting this diagnosis included: responsiveness to acid suppression therapy, abnormal reflux monitoring or the identification of specific novel endoscopic and histological findings. Functional heartburn was considered a separate entity not related to acid reflux. Proton pump inhibitors are the definitive therapy for NERD, with efficacy best evaluated by validated quality-of-life instruments. Adjunctive antacids or H₂ receptor antagonists are ineffective, surgery seldom indicated. Conclusions: Little is known of the pathobiology of NERD. Further elucidation of the mechanisms of mucosal and visceral hypersensitivity is required to improve NERD management.

Esomeprazole regimens for reflux symptoms in Chinese patients with chronic gastritis

“…Patient satisfaction evaluation in NERD studies has been used as an important outcome measure [16] . Ideally, this should be evaluated using a validated questionnaire [17] .…”

In vitro effects of famotidine and ranitidine on lower esophageal sphincter tone in rats

“…When this condition persists, damage to the esophagus by gastric hydrochloric acid and other noxious agents, including pepsin, was seen (27). Nonerosive reflux disease (NERD) is a subcategory of GERD in which patients show no erosive esophagitis on upper endoscopy, and it accounts for 60-70% of GERD (28)(29)(30).…”

Actual Aspects of Anti-Secretor Therapy of Gastroesophageal Reflux Disease

“…Если изжога вызвана ретроградным забросом кислого содержимого, то она довольно легко снимается питьевой содой, молоком или щелочными минеральными водами. Особенностью изжо-ги при ГЭРБ является зависимость от положения тела: изжога возникает при наклонах туловища вперед или в положении лежа [8][9][10].…”