What is nonerosive reflux disease?

Question: What is nonerosive reflux disease?

Answer: For some patients, GERD can cause erosive esophagitis, a condition that causes inflammation, swelling, or irritation of the esophagus. There have been studies, however, that have found that less than half of GERD patients actually suffer from esophagitis. The majority of patients actually have what is called nonerosive reflux disease (NERD). With NERD, patients experience typical GERD symptoms caused by acid reflux, but they do not have visible esophageal injury.

Depending on the severity of symptoms, treatment may involve one or more of the following lifestyle changes or medications.

Lifestyle changes for the treatment of NERD:

Avoid reflux-producing foods These foods include fried or fatty foods, citrus fruits and juices, tomato-based products, caffeine, alcohol, chocolate, peppermint, and pepper.

If you smoke, stop Smoking inhibits the production of saliva, stimulates the production of stomach acid, and can weaken and relax the lower esophageal sphincter (LES). Saliva is one of your body's defenses against damage to the esophagus, and it aids in neutralizing refluxed acid.

Do not drink alcohol Alcohol increases the production of stomach acid, and relaxes the LES (allowing stomach contents to reflux back up into the esophagus). It can make the esophagus more sensitive to stomach acid, too.

Eat small meals Large meals expand your stomach and increase upward pressure against the esophageal sphincter.

Avoid lying down for 3 hours after a meal Gravity helps to keep the stomach juices from backing up into the esophagus. Lying down with a full stomach makes reflux more likely.

Raise the head of your bed With the head higher than the stomach, gravity helps reduce upward pressure. You can elevate your head by either elevating the head of your bed 6 to 8 inches, using a foam wedge under the head of the mattress, or using a wedge pillow to elevate your shoulders and head.

Medications for the Treatment of NERD:

Your doctor may recommend over-the-counter antacids, which work by neutralizing acid in the stomach, or medications that stop acid production. Your doctor will talk to you about which medication is best for you, and how long they should be taken.

Antacids, such as Maalox, Mylanta, Tums, and Rolaids, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms.

H2 blockers, such as Tagamet, Pepcid, Axid, and Zantac, impede acid production. They are available in prescription strength and over the counter.

Proton pump inhibitors include Prilosec, Prevacid, Protonix, Aciphex, and Nexium, which are all available by prescription. Prilosec is available in an over-the-counter form (Prilosec OTC). Proton pump inhibitors (PPIs) are a group of medications that prevent the release of acid in the stomach and intestines.

_Sources:

_{Kenneth R. DeVault M.D., F.A.C.G, Donald O. Castell M.D., M.A.C.G.. "Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease." doi: 10.1111/j.1572-0241.2005.41247.x. American College of Gastroenterology. 8 Nov 2009.}

_{"Omeprazole for Nonerosive Reflux Disease." Journal Watch Gastroenterology. 8 Nov 2009.}