Non Erosive Reflux Disease has been recognized as a form of GERD only in the recent decade and is considered an important achievement of help the patients of specific type of GERD to get the right treatment. While the definition of NERD has not changed over the years but its better recognition has not enabled the doctors to correctly identify the patients of NERD and make the count right. With Esophageal Impedence +pH monitoring it has become easy now to diagnose and assess the patients of NERD. Though therapeutic modalities still focus on acid suppression treatments but there is a growing awareness among the medical community at large that other therapeutic strategies should also be considered for NERD.
GERD patients fall into 2 sub categories: Non erosive Reflux Disease and Erosive Reflux Disease. Both of these have different pathophysiological and clinical characteristics which gives birth to the need of finding different treatment methods are also mentioned above. This takes priority because the main difference between the two acid reflux patients is that the former do not respond to proton pump inhibitors and that is why they form the majority portion of the group that suffers from refractory heartburn.
Definition: Nonerosive GERD is normally defined as the GERD where the patient does not have any classical GERD symptoms which are injury in the mucosal region of esophagus.The new acceptable definition for the disease states NERD to be a form of GERD which lacks Barrett's esophagus or definite endoscopic esophageal mucosal breaks (erosion or ulceration).
Prevalence: According to some recent studies, out of the total GERD patients, around 50-70% are suggested to be suffering from Non Erosive Reflux Disease. However, the researchers mention that this figure is contaminated because the use of proton pump inhibitors have become so extensive nowadays that this count may even include healed patients who had erosive GERD.
Tests have demonstrated that the acidic reflux content in the esophagus of NERD patients is mostly normal when compared to patients of Barrett's esophagus and erosive reflux disease. Studies show that in patients of Barrett's esophagus and erosive reflux disease the acid content is very high in the distal areas of the esophagus; whereas in NERD patients the acid exposure distribution does not show much distribution. This leads us to conclude that the reasons of heartburn in NERD patients are quite different compared to patients of Barrett's esophagus and erosive reflux disease. The reasons can vary from generic to environmental factors.
Diagnosis: Few symptoms are functional bowel disorders like functional dyspepsia and irritable bowel syndrome, psychological disorders, and positive acid perfusion test. However, it is better to go for medical tests to confirm your type of GERD.
Primary test for NERD patients is Esophageal Impedence +pH monitoring. This will confirm the type of GERD which is causing you heartburn. This will involve upper endoscopy to see if you have any mucosal injury in your esophagus which are the symptoms of Erosive GERD.
Treatment: Proton pump inhibitors are considered to be the best treatment of both types of GERD patients- Erosive or non Erosive. However, around 20-30% of the patients might not respond to treatments from PPIs. PPI medicines which are to be taken after a prescription from a certified medical expert are pantoprazole (20 mg/day) and esomeprazole (20 mg/day). Another novel medication is Dexlansoprazole 30 mg/day for 4 weeks which provides extended acid-suppression and works for most NERD patients. This too is a prescription drug.
Conclusion: Differentiating between the two types of GERD patients is a difficult task and studies are still going on for better diagnosis methods as well as therapeutic treatments. If you are a NERD patient then you can rest assured that you are not going to progress to erosive form of GERD or Barrett's esophagus due to this. NERD is not a progressive disease and can easily be treated with a healthy lifestyle and proper medical attention in patients with regular GERD symptoms.
GERD patients fall into 2 sub categories: Non erosive Reflux Disease and Erosive Reflux Disease. Both of these have different pathophysiological and clinical characteristics which gives birth to the need of finding different treatment methods are also mentioned above. This takes priority because the main difference between the two acid reflux patients is that the former do not respond to proton pump inhibitors and that is why they form the majority portion of the group that suffers from refractory heartburn.
Definition: Nonerosive GERD is normally defined as the GERD where the patient does not have any classical GERD symptoms which are injury in the mucosal region of esophagus.The new acceptable definition for the disease states NERD to be a form of GERD which lacks Barrett's esophagus or definite endoscopic esophageal mucosal breaks (erosion or ulceration).
Prevalence: According to some recent studies, out of the total GERD patients, around 50-70% are suggested to be suffering from Non Erosive Reflux Disease. However, the researchers mention that this figure is contaminated because the use of proton pump inhibitors have become so extensive nowadays that this count may even include healed patients who had erosive GERD.
Tests have demonstrated that the acidic reflux content in the esophagus of NERD patients is mostly normal when compared to patients of Barrett's esophagus and erosive reflux disease. Studies show that in patients of Barrett's esophagus and erosive reflux disease the acid content is very high in the distal areas of the esophagus; whereas in NERD patients the acid exposure distribution does not show much distribution. This leads us to conclude that the reasons of heartburn in NERD patients are quite different compared to patients of Barrett's esophagus and erosive reflux disease. The reasons can vary from generic to environmental factors.
Diagnosis: Few symptoms are functional bowel disorders like functional dyspepsia and irritable bowel syndrome, psychological disorders, and positive acid perfusion test. However, it is better to go for medical tests to confirm your type of GERD.
Primary test for NERD patients is Esophageal Impedence +pH monitoring. This will confirm the type of GERD which is causing you heartburn. This will involve upper endoscopy to see if you have any mucosal injury in your esophagus which are the symptoms of Erosive GERD.
Treatment: Proton pump inhibitors are considered to be the best treatment of both types of GERD patients- Erosive or non Erosive. However, around 20-30% of the patients might not respond to treatments from PPIs. PPI medicines which are to be taken after a prescription from a certified medical expert are pantoprazole (20 mg/day) and esomeprazole (20 mg/day). Another novel medication is Dexlansoprazole 30 mg/day for 4 weeks which provides extended acid-suppression and works for most NERD patients. This too is a prescription drug.
Conclusion: Differentiating between the two types of GERD patients is a difficult task and studies are still going on for better diagnosis methods as well as therapeutic treatments. If you are a NERD patient then you can rest assured that you are not going to progress to erosive form of GERD or Barrett's esophagus due to this. NERD is not a progressive disease and can easily be treated with a healthy lifestyle and proper medical attention in patients with regular GERD symptoms.
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