Nonerosive reflux disease as a presentation of gastro-oesophageal reflux disease

Up to 70% of patients with typical symptoms of gastro-oesophageal reflux disease have neither definite endoscopic oesophageal erosions, nor Barrett's oesophagus at upper endoscopy. These patients suffer from nonerosive reflux disease (NERD). There is no gold standard for the diagnosis of NERD, but a comprehensive history is usually sufficient to confirm the diagnosis, and initiate therapy. A sensitive tool for the diagnosis of NERD is a proton-pump inhibitor (PPI) trial of therapy. The aims of NERD therapy are acute and long-term symptom relief, maintenance of clinical remission, and restoration of quality of life. PPIs, in full doses, are the treatment of choice for NERD patients, who often need long-term therapy for symptom control. Identification of the relevant symptoms and initiation of treatment, where symptoms that cause alarm have been excluded, is important in the effective management of NERD for the family physician.