Nonerosive Reflux Disease (NERD) - An Update

Hershcovici, Tiberiu; Fass, Ronnie

doi:10.5056/jnm.2010.16.1.8

Cited by 118 publications

(100 citation statements)

References 108 publications

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“…NERD adults on PPI therapy demonstrate some features that are significantly different from PPInaïve patients, but similar to EE patients. This observation supports the notion that some PPI-NERD patients are actually healed EE patients, and that an overlap does exist between the GERD phenotypes [33] . Evidence from adult studies indicates that visible breaks in the esophageal mucosa are the endoscopic signs of greatest interobserver reliability [34,35] .…”

Section: Egd and Biopsy In Gerdsupporting

confidence: 79%

Managing gastroesophageal reflux disease in children: The role of endoscopy

Goldani¹

2012

WJGE

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Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.

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Section: Egd and Biopsy In Gerdsupporting

confidence: 79%

Managing gastroesophageal reflux disease in children: The role of endoscopy

Goldani¹

2012

WJGE

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“…In fact, NERD patients have a significantly lower symptomatic response rate (by 20-30%) to PPI therapy as compared with patients having EE; consequently, NERD contributes the highest number of GERD patients to the refractory heartburn group. 2,15 In a systematic review of the literature, PPI symptomatic response pooled rate was 36.7% in NERD patients and 55.5% in EE patients. 21 The therapeutic gain was 27.5% in NERD compared with 48.9% in EE.…”

Section: Advanced Grades Of Erosive Esophagitismentioning

confidence: 99%

“…Overall, the results of recent epidemiological studies suggest that the prevalence of NERD in the GERD population is approximately 70%. 2 NERD is one of the major areas of unmet need in the treatment of GERD and is related to less than optimal response to PPI therapy. In fact, NERD patients have a significantly lower symptomatic response rate (by 20-30%) to PPI therapy as compared with patients having EE; consequently, NERD contributes the highest number of GERD patients to the refractory heartburn group.…”

Section: Advanced Grades Of Erosive Esophagitismentioning

confidence: 99%

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

Dickman

Maradey–Romero

Gingold‐Belfer

et al. 2015

J Neurogastroenterol Motil

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Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need.

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“…67 Depression and anxiety are more common in women than in men in the general population. [88][89][90] The prevalence of NERD is also more common in women. Accordingly, comorbid depression and anxiety may play a role to the increased symptom burden in women.…”

Section: Psychological Factorsmentioning

confidence: 99%

Sex and Gender Differences in Gastroesophageal Reflux Disease

Kim

2016

J Neurogastroenterol Motil

122

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It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.

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Nonerosive Reflux Disease (NERD) - An Update

Cited by 118 publications

References 108 publications

Managing gastroesophageal reflux disease in children: The role of endoscopy

Managing gastroesophageal reflux disease in children: The role of endoscopy

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

Sex and Gender Differences in Gastroesophageal Reflux Disease

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