Untangling Nonerosive Reflux Disease From Functional Heartburn

Heartburn is a common symptom in clinical practice, but as many 70% of patients have normal findings from upper endoscopy. Most these nonerosive reflux disease (NERD) or functional esophageal disorders. NERD the most phenotype gastroesophageal disease, and heartburn cause for refractory heartburn. In with NERD, symptoms arise hypersensitivity, whereas heartburn, result hypersensitivity. A diagnosis requires endoscopy testing, also manometry. treated commonly medical, endoscopic, surgical antireflux approaches, well can be neuromodulators, psychological intervention, complementary medicine options. Gastroesophageal (GER) physiological process that often occurs during after meals. However, acid neutralization by saliva peristalsis leads to prompt clearance physiologic refluxate, leading GER only minority people. (GERD) when frequent caustic enough typical regurgitation, dysphagia without mucosal damage.1Vakil N. van Zanten S.V. Kahrilas P. et al.The Montreal definition classification disease: global evidence-based consensus.Am J Gastroenterol. 2006; 101 (quiz 1943): 1900-1920Crossref PubMed Scopus (2360) Google Scholar GERD composed 3 phenotypes: (1) erosive (ERD; defined endoscopic evidence reflux-related injury), (2) Barrett’s esophagus, (3) (NERD; abnormal exposure based on pH injury endoscopy).2Gyawali C.P. P.J. Savarino E. al.Modern GERD: Lyon Consensus.Gut. 2018; 67: 1351-1362Crossref (295) All aforementioned GERD-related disorders present primarily regurgitation. Thus, ubiquitously attributed GERD, it important recognize although do and/or not GERD. disorder. There are 2 setting endoscopy, They include (FH) hypersensitivity (RH; association time).2Gyawali Recognition has improved our understanding who now classified into either FH, RH testing. The aim this review provide better evolution definitions, diagnostic management strategies FH. consensus meeting 2006 “a condition which develops stomach contents causes troublesome complications.”1Vakil subsequently presence reflux-associated (heartburn regurgitation) absence breaks endoscopy.”1Vakil Vevey 2009 further refined “troublesome erosions/breaks at conventional recent suppressive therapy.”3Modlin I.M. Hunt R.H. Malfertheiner al.Diagnosis non-erosive disease--the Consensus Group.Digestion. 2009; 80: 74-88Crossref (0) Although recognized FH separate entity related reflux, both consensuses failed testing helps between This led efforts Rome committee toward refining subcharacterizing objective metrics. term was introduced literature late 1980s through early 1990s advent II criteria disorders.4Clouse R.E. Richter J.E. 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