Epidemiology of Non-Erosive Reflux Disease

Abstract

Non-erosive reflux disease (NERD) is a relatively new entity, the definition of which has been evolving and involves the use of symptoms, endoscopy, and objective evidence of reflux or reflux-related damage. The closest entity to NERD that is examined by available epidemiologic studies is defined by the presence of gastroesophageal reflux disease (GERD) symptoms in the absence of esophageal erosions or Barrett’s esophagus. In this review, I identified two population-based studies, one non-community study, and several endoscopy-based studies that provided information on several aspects of NERD. Most of GERD is NERD (50–85%), and therefore one can estimate 11–12% of the general population and considerably higher proportions of patients presenting to endoscopy (37–87%) may have NERD. Risk factors for NERD including absence of hiatus hernia, low BMI, and presence of Helicobacter pylori indicate that it is a ‘milder’ part of the GERD spectrum. Other associations of NERD include younger age, female sex, and psychological comorbidities that resemble those of functional gut disorders. The temporal trends in NERD are unclear, and are probably increasing because GERD symptom prevalence has increased.

Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

“…This may be attributed to the difference in diagnostic criteria for NERD and FH. Unlike our results, previous observations showed that NERD was associated with younger age, female sex, and psychological comorbidities than ERD [17]. In those observations, the criteria used were different from the Rome III criteria, where NERD was simply defined by the presence of GERD symptoms in the absence of esophageal erosions or Barrett’s esophagus.…”

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

“…NERD is probably increasing at least as fast as its ‘parent’ GERD, though it was appreciated that there was little direct evidence to support this assertion [10]. The increase in GERD parallels the increase in obesity in developed nations [11], but the group just failed to support the statement that BMI is contributing to an increase in NERD, principally due to a paucity of research addressing this issue.…”

Non-Erosive Reflux Disease (NERD), Symptomatic and Asymptomatic Erosive Reflux Disease (ERD): From Hypersensitive to Hyposensitive Esophagus

“…It has been reported that a significant proportion (up to 75%) of patients with GERD in this region falls under the ''endoscopy-negative'' or non-erosive reflux disease (NERD) group [2]. Although patients with erosive reflux disease (ERD) and NERD are often regarded as part of the spectrum of the same disease, they are different in many ways and are considered by some as different disease entities [3].…”