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From: trigonometry1972 on 13 Sep 2007 07:00
Curr Treat Options Gastroenterol. 2007 Aug;10(4):305-311.

Functional Heartburn, Nonerosive Reflux Disease, and Reflux
Esophagitis Are All Distinct Conditions--A Debate: Con.

Fry LC, Mönkemüller K, Malfertheiner P.

Peter Malfertheiner, MD Department of Gastroenterology, Hepatology,
and
Infectious Diseases, Universitätsklinikum Magdeburg, Otto-von-Guericke
University, Leipziger Straße 44, 39120 Magdeburg, Germany.
Peter.Malfertheiner(a)medizin.uni-magdeburg.de.

Gastroesophageal reflux disease (GERD) is currently defined as a
condition that develops when the reflux of stomach contents causes
recurrent symptoms and/or complications. The clinical presentation of
GERD has been recognized to be much broader than before, when the
typical symptoms of heartburn and acid regurgitation were considered
as the main clinical presentation. However, now it is recognized that
GERD can present with various other mainly extraesophageal symptoms,
abdominal pain, and even sleep disturbance. Moreover, there is an
important overlap with functional gastrointestinal disorders such as
functional dyspepsia and irritable bowel syndrome. The morphologic
spectrum of esophageal involvement in GERD encompasses erosive
(erosive reflux disease ), Barrett's esophagus (BE), and nonerosive
reflux disease (NERD). However, there is still no consensus on whether
GERD represents one disease that can progress from NERD to
ERD and BE, or whether it is a spectrum of different conditions with
its own
clinical, pathophysiologic, and endoscopic characteristics. Recently
published data suggest that mild erosive esophagitis behaves in a way
similar to NERD and that there is considerable movement between these
categories. But follow-up data also show that after 2 years, some
patients with NERD or GERD Los Angeles A or B went on to develop
severe GERD or even BE. A practical approach is to categorize patients
with reflux symptoms into "functional heartburn" (ie, reflux symptoms
and negative endoscopy and absent objective evidence of acid reflux
into the esophagus), NERD (negative endoscopy but positive
documentation of acid reflux into the esophagus), and ERD (erosions
documented endoscopically). In conclusion,
it appears that GERD is a disease with a spectrum of clinical and
endoscopic
manifestations, with characteristics that make it a continuum and not
a
categorical condition with separate entities. It is difficult to
clearly
delineate the spectrum of GERD based on the clinical, endoscopic, and
pathophysiologic characteristics, but therapeutic trials and follow-up
studies
suggest that GERD is not composed of different conditions.

PMID: 17761123

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