Nonerosive reflux disease: Clinical concepts

C. Prakash Gyawali, Dan E. Azagury, Walter W. Chan, Servarayan M. Chandramohan, John O. Clarke, Nicola de Bortoli, Edgar Figueredo, Mark Fox, Daniela Jodorkovsky, Adriana Lazarescu, Peter Malfertheiner, Jan Martinek, Kenric M. Murayama, Roberto Penagini, Edoardo Savarino, Katerina P. Shetler, Ellen Stein, Roger P. Tatum, Justin Wu

Research output: Contribution to journalArticlepeer-review


Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

Original languageEnglish
Pages (from-to)290-303
JournalAnnals of the New York Academy of Sciences
Issue number1
Publication statusPublished - 2018


  • Ambulatory reflux monitoring
  • Antireflux surgery
  • Esophageal manometry
  • Nonerosive reflux disease
  • Proton pump inhibitors

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • History and Philosophy of Science


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