Nerd

Abstract: Summary Background: Recent reports suggest that patients with non-erosive reflux disease (NERD) treated with anti-reflux medications show lower symptom improvement rates than patients with erosive oesophagitis treated with the same medications Aim: To determine the acid reflux and symptom patterns of patients with NERD in comparison with those with erosive oesophagitis and Barrett's oesophagus, and to identify different NERD subgroups Methods: One hundred and forty-nine consecutive patients seen for classic heartburn symptoms were evaluated for the study Oesophageal mucosal injury was assessed by upper endoscopy and classified by Hetzel–Dent criteria Patients with Hetzel–Dent grades 0–1 were considered to have NERD The extent of oesophageal acid exposure was determined by ambulatory 24-h oesophageal pH monitoring Results: Seventy-one patients were found to have NERD, 36 erosive oesophagitis and 42 Barrett's oesophagus Compared with patients with erosive oesophagitis (75%) and Barrett's oesophagus (93%), those with NERD (45%) were significantly less likely to have an abnormal pH test (P = 00001) Patients with Barrett's oesophagus had the highest mean number of acid reflux events (210 ± 177), compared with those with erosive oesophagitis (1397 ± 152) and NERD (953 ± 94) (P = 00001); however, the rate of perceived acid reflux events was similar and very low in all groups (NERD, 36%; erosive oesophagitis, 29%; Barrett's oesophagus, 217%) NERD-positive patients (abnormal pH test) had a similar extent of oesophageal acid exposure to those with erosive oesophagitis NERD-positive patients were more likely to demonstrate a symptom index greater than 75% than NERD-negative patients (normal pH test) (619% vs 105%; P = 00001) In the NERD-negative group, those with a negative symptom index reported having heartburn at pH < 4 only 127% of the time, compared with 707% of the time in those with a positive symptom index, despite a similar mean number of heartburn episodes Conclusions: Patients with NERD commonly demonstrate a negative pH test Acid reflux characteristics and symptom patterns suggest a heterogeneous group of patients

Abstract: Summary Background and aims: Gastro-oesophageal reflux disease (GERD) can be associated with a variety of extra-oesophageal disorders (EED) such as chronic cough, asthma, laryngeal disorder or chest pain The aim of the study was to estimate and compare the prevalence of EED in a population with symptomatic GERD presenting as either erosive reflux disease (ERD) or non-erosive reflux disease (NERD) Methods: Baseline data were collected from a prospective, multicentre, open cohort study (ProGERD) in which patients will be followed for 5 years after initial treatment with esomeprazole Within the framework of this trial, all patients underwent gastroscopy and filled out a questionnaire designed to assess EED The influence of potential prognostic factors on the prevalence of EED was analysed by multivariate (stepwise logistic regression) analysis Results: 6215 patients (3303 male, 2912 female; mean age 54 years) presenting with heartburn were included EED was detected in 328% of all patients The proportion was significantly higher (P = 00002) in ERD patients (349%) than in NERD patients (305%) As judged from the multivariate analysis, female gender, age, oesophagitis of LA grade C/D, duration of GERD disease greater than 1 years and smoking were significantly associated with EED ERD patients with oesophagitis of LA grade A or B did not have a significantly higher risk of EED than patients with NERD Conclusions: Patients with GERD have a high probability of experiencing EED, which may be associated with a number of prognostic factors such as duration and severity of GERD Extra-oesophageal disorders are slightly, but statistically, more prevalent in ERD than in NERD patients

Abstract: Nonerosive reflux disease (NERD) and erosive esophagitis are the main presentations of gastroesophageal reflux disease. However, NERD is the most common presentation of gastroesophageal reflux disease in community-based patients. Patients with NERD differ in demographic characteristics from patients with erosive esophagitis, primarily in sex distribution, weight/body mass index, and prevalence of hiatal hernia. Physiologically, patients with NERD tend to have normal lower esophageal sphincter resting pressure, minimal esophageal body motility abnormalities, low esophageal acid exposure profile and minimal nighttime esophageal acid exposure. Patients with NERD have a lower symptom response rate to proton pump inhibitor once daily than patients with erosive esophagitis. Additionally, NERD patients demonstrate a longer lag-time for symptom resolution and lack of difference in symptom response rate between half to full dose proton pump inhibitor as compared with patients with erosive esophagitis.