Non-erosive reflux disease - what we know so far

Non-erosive reflux disease (NERD) is the most common phenotypic presentation of gastro-oesophageal reflux disease (GORD) with physiological, pathophysiological, anatomical and histological characteristics that are unique to this subgroup of GORD. Moreover, NERD accounts for the majority of reflux patients who fail proton-pump inhibitor (PPI) treatment. For these reasons, NERD has represented one of the most attractive areas for research and novel developments in the last decade. Current investigations in NERD are focussed primarily on understanding its pathophysiology, natural history and the various stimuli able to provoke symptoms in patients. The diagnosis of the complex NERD population remains a difficult task, but the recent introduction of oesophageal impedance-pH monitoring has contributed to a clearer and objectively reliable diagnosis. In particular, this test has allowed the objective identification of real NERD from functional heartburn patients, who do not belong to the realm of GORD. Therapeutic modalities still focus on acid suppression, but there is growing interest in finding and developing other therapeutic strategies in NERD.