How relevant is symptom evaluation in NERD?

Most patients presenting with esophageal and extraesophageal symptoms of gastroesophageal reflux disease (GERD) have negative endoscopic findings and are defined as being affected by non-erosive reflux disease (NERD). A correct recognition and analysis of symptoms in these patients is essential for an appropriate clinical management, as well as for scientific purposes. Symptoms alone do not capture all the clinical implications of NERD, but since their frequency and severity are strictly related to their influence on quality of life, they provide a sufficiently reliable picture of the disease. Most studies were carried out on patients with heartburn and regurgitation, and information about other clinical manifestations of NERD is extremely limited. Inclusion criteria and primary end-points of clinical trials are ill defined, particularly, when extraesophageal manifestations are considered. A new, validated instrument is now available to correctly measure all possible complains of GERD patients, including general well-being. This scale has been used also to identify the level of symptom frequency and severity that can be present in perfectly healthy, self-considering asymptomatic individuals, thus providing the first objective definition of 'complete symptom relief'. Through instruments like this, our understanding of NERD and its management will certainly further improve in the years to come.