NERD, GERD, and beyond: A consideration of the expanding spectrum of gastroesophageal reflux disease

Nonerosive reflux disease (NERD) is an important and common manifestation of gastroesophageal reflux disease (GERD) that impairs quality of life and responds to therapy. NERD, however, is not homogenous and includes some who, ultimately, may be documented to have a microscopic form of esophagitis, others who demonstrate a normal degree of acid exposure but in whom acid reflux events and symptoms are clearly associated (the "sensitive esophagus") and a final group, functional heartburn, in whom no such linkage between acid reflux and symptoms exists. On the basis of the latter, and of its frequent overlap with other functional gastrointestinal disorders, whose demographic and pathophysiologic features it also shares, this author proposes that functional heartburn be removed for the spectrum of GERD and placed where it belongs, among the functional gastrointestinal disorders. In this way, studies of the epidemiology, pathophysiology, and therapy of GERD and NERD can be better interpreted. Symptom severity and frequency predict quality of life impact and should provide a clinical definition of GERD, which is useful in clinical practice and invaluable in research.