Diagnosis and management of non-erosive reflux disease–the Vevey NERD Consensus Group
Open accessAbstract
BACKGROUND/AIMS: Although considerable information exists regarding gastroesophageal reflux disease with erosions, much less is known of non-erosive reflux disease (NERD), the dominant form of reflux disease in the developed world. METHODS: An expert international group using the modified Delphi technique examined the quality of evidence and established levels of agreement relating to different aspects of NERD. Discussion focused on clinical presentation, assessment of clinical outcome, pathobiological mechanisms, and clinical strategies for diagnosis and management. RESULTS: Consensus was reached on 85 specific statements. NERD was defined as a condition with reflux symptoms in the absence of mucosal lesions or breaks detected by conventional endoscopy, and without prior effective acid-suppressive therapy. Evidence supporting this diagnosis included: responsiveness to acid suppression therapy, abnormal reflux monitoring or the identification of specific novel endoscopic and histological findings. Functional heartburn was considered a separate entity not related to acid reflux. Proton pump inhibitors are the definitive therapy for NERD, with efficacy best evaluated by validated quality-of-life instruments. Adjunctive antacids or H(2) receptor antagonists are ineffective, surgery seldom indicated. CONCLUSIONS: Little is known of the pathobiology of NERD. Further elucidation of the mechanisms of mucosal and visceral hypersensitivity is required to improve NERD management.
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The findings are similar to what is observed in human microscopic reflux esophagitis, and would be assigned a Grade M in accordance with the updated Los Angeles classification.
“These findings are similar to what is observed in human microscopic reflux esophagitis, and would be assigned a Grade M in accordance with the updated Los Angeles classification [2].”
From Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis (2014) · cites this paper as [2]
The section headed “Grade of evidence = Very low” describes microscopic histological changes in human non-erosive reflux disease, including basal zone hyperplasia and dilated intercellular spaces. It does not identify the citing paper’s findings, so their similarity cannot be assessed from this source; nor does it assign those changes Grade M under an updated Los Angeles classification. No page number is available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPostprandial hyperglycemia is a risk factor for acid reflux and the development of non-erosive esophagitis.
“Postprandial hyperglycemia is a risk factor for acid reflux and the development of non-erosive esophagitis.”
From Cytoprotective Effects of Hydrogen Sulfide in Novel Rat Models of Non-Erosive Esophagitis (2014) · cites this paper as [2]
The section on weakly acidic reflux discusses acid exposure and symptom generation in NERD, but not postprandial blood glucose. Searches for postprandial hyperglycemia, glucose and diabetes found no passage linking elevated blood glucose to acid reflux or the development of non-erosive esophagitis; the paper instead identifies hiatus hernia as a risk factor for esophagitis. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Modlin, I. M., Hunt, R. H., Malfertheiner, P., Moayyedi, P., Quigley, E. M., Tytgat, G. N. J., Tack, J., Heading, R. C., Holtman, G., & Moss, S. F.
- Affiliations
- Yale University (US)
- McMaster University Medical Centre (CA)
- Otto-von-Guericke-Universität Magdeburg (DE)
- University College Cork (IE)
- University of Amsterdam (NL)
- KU Leuven (BE)
- Glasgow Royal Infirmary (GB)
- Brown University (US)
- Venue
- Digestion
- Publisher
- S. Karger AG
- Published
- 2009
- Volume
- 80
- Issue
- 2
- Pages
- 74-88
- ISSN
- 0012-2823 (ISSN-L)
- 1421-9867
- PMC
- PMC2790735
- OpenAlex
- W1990566132
- Cited by
- 154
- References
- 96
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 12 · 2022: 8 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 9 · 2016: 13 · 2015: 11 · 2014: 12 · 2013: 9 · 2012: 11
- FWCI
- 12.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Digestion (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Keywords
- non-erosive reflux disease, gastroesophageal reflux disease, proton pump inhibitors, acid suppression, functional heartburn, visceral hypersensitivity, reflux monitoring, antacids, H2 receptor antagonists, antireflux surgery, quality of life, pathobiology
- MeSH terms
- Gastroesophageal Reflux, Humans, Quality of Life, Severity of Illness Index, Practice Guidelines as Topic
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