Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien 970, Taiwan.
Gastroenterol Res Pract. 2013;2013:653989. doi: 10.1155/2013/653989. Epub 2013 Jul 11.
Nonerosive reflux disease (NERD) is a distinct pattern of gastroesophageal reflux disease (GERD). It is defined as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal mucosal erosions/breaks at conventional endoscopy. In clinical practice, patients with reflux symptoms and negative endoscopic findings are markedly heterogeneous. The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep), and sustained esophageal contractions. The use of 24-hour esophageal impedance and pH monitoring gives further insight into reflux characteristics and symptom association relevant to NERD. The treatment choice of NERD still relies on acid-suppression therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily) for 2-4 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily) is recommended. In patients with poor response to appropriate PPI treatment, 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid-reflux-related NERD (hypersensitive esophagus), nonacid-reflux-related NERD, and functional heartburn. The response is less effective in NERD as compared with erosive esophagitis.
非糜烂性反流病（NERD）是一种独特的胃食管反流病（GERD）模式。它被定义为 GERD 的一个亚类，其特征为在常规内镜检查中无食管黏膜糜烂/破损的情况下出现烦人的反流相关症状。在临床实践中，具有反流症状和阴性内镜结果的患者表现出明显的异质性。NERD 中症状产生的潜在解释包括微观炎症、内脏高敏性（压力和睡眠）和持续的食管收缩。使用 24 小时食管阻抗和 pH 监测可进一步深入了解与 NERD 相关的反流特征和症状关联。NERD 的治疗选择仍然依赖于抑酸治疗。最初，患者可以通过质子泵抑制剂（PPI；标准剂量，每日一次）治疗 2-4 周。如果初始治疗未能引起足够的症状控制，则建议增加 PPI 剂量（标准剂量 PPI 每日两次）。对于对适当的 PPI 治疗反应不佳的患者，建议进行 24 小时食管阻抗和 pH 监测，以区分酸反流相关的 NERD、弱酸性反流相关的 NERD（食管高敏性）、非酸反流相关的 NERD 和功能性烧心。与糜烂性食管炎相比，NERD 的反应效果较差。
