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The spectrum of gastroesophageal reflux disease (GERD) has expanded. Not all patients with GERD are alike. In fact, most patients with symptomatic GERD do not have erosive reflux disease (ERD). Instead, they are said to have nonerosive, or negative-endoscopy, reflux disease (NERD). NERD differs from GERD in several significant ways. For example, NERD patients appear to be relatively resistant to proton pump inhibitors and, therefore, may not be good surgical candidates.
A series of articles on the diagnosis, treatment, and management of GERD/NERD were published recently in a supplement to Alimentary Pharmacology & Therapeutics. One article presented an update on NERD, a condition that may affect up to 70% of patients in the community who have GERD.This high percentage of NERD patients contrasts with that of patients seen in gastroenterologic practice or in tertiary referral centers, most of whom have esophagitis or complicated GERD. This distinction is important because most studies of diagnostic or therapeutic interventions in GERD have been performed in the latter setting, and findings may not be applicable to patients with NERD.