Document Detail

Review article: the role of acid suppression in patients with non-erosive reflux disease or functional heartburn.
MedLine Citation:
PMID:  16483268     Owner:  NLM     Status:  MEDLINE    
When patients with the typical reflux symptoms of heartburn, regurgitation, or both, undergo endoscopy, up to 75% will not have endoscopic oesophagitis or evidence of Barrett's oesophagus. These patients have been described as having endoscopic negative or, more commonly, non-erosive reflux disease (NERD). Patients without oesophagitis, but with a positive pH test, can be diagnosed with gastro-oesophageal reflux disease (GERD). Some experts also consider a response to proton pump inhibitor therapy as proof of GERD in a patient with the correct symptoms and a negative endoscopy. Patients with normal acid exposure, but who report symptoms with a majority of their reflux episodes documented during an ambulatory pH study, have also been considered to have NERD, although others have labelled them as having 'functional heartburn'. Finally, there are some patients who have reflux symptoms and respond to reflux therapy, but have no demonstrable reflux by either endoscopy or ambulatory reflux testing. Whether these patients are part of the GERD spectrum or have another diagnosis is not clear. It seems that the most widely used definition of functional disease (the Rome II criteria) would include these patients as having functional heartburn, as it was defined as 'greater than or equal to 12 weeks of either continuous or intermittent symptoms of burning retrosternal discomfort or pain without pathologic GERD, achalasia, or other motility disorders with a recognized pathologic basis'. This article reviews potential differences in pathophysiology between erosive oesophagitis and NERD; explores whether symptoms can help distinguish NERD patients from erosive oesophagitis patients; and explores the evaluation and therapy of these patients.
K R DeVault
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  23 Suppl 1     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-17     Completed Date:  2006-08-21     Revised Date:  2013-04-16    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  33-9     Citation Subset:  IM    
Division of Gastroenterology and hepatology, Mayo Clinic College of Medicine, Jacksonville, FL 32233, USA.
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MeSH Terms
Anti-Ulcer Agents / therapeutic use
Benzimidazoles / therapeutic use
Endoscopy, Digestive System
Esophagitis, Peptic / drug therapy,  physiopathology
Gastric Acid / physiology*
Gastroesophageal Reflux / drug therapy,  physiopathology*
Heartburn / physiopathology*
Hydrogen-Ion Concentration
Omeprazole / analogs & derivatives,  therapeutic use
Proton Pumps / antagonists & inhibitors
Time Factors
Treatment Outcome
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Ulcer Agents; 0/Benzimidazoles; 0/Proton Pumps; 32828355LL/rabeprazole; 73590-58-6/Omeprazole

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