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Nonerosive Reflux Disease - NERD

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Updated June 11, 2014

Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus.

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

Treating Nonerosive Reflux Disease

Treatment for NERD is similar to that for erosive GERD. Depending on the severity of symptoms, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes

Avoid reflux-producing foods, including:

  • Fried foods
  • Fatty foods
  • Citrus fruits
  • Tomato products
  • Caffeine
  • Alcoholic beverages
  • Citrus fruit drinks
  • Chocolate
  • Peppermint
  • Pepper

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

Do not drink alcohol.
Alcohol increases the production of stomach acid, relaxes the lower esophageal sphincter, allowing stomach contents to reflux back up into the esophagus, and can make the esophagus more sensitive to stomach acid.

Lose weight if needed.
Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. Losing weight may help reduce acid reflux.

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

Wear loose-fitting clothes.
Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

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 in a couple of ways. You can place bricks, blocks or anything that's sturdy under the legs at the head of your bed to raise it 6 to 8 inches. A foam wedge under the mattress can also be used. You can also use a wedge pillow to elevate your shoulders and head.


Medications

Your doctor may recommend over-the-counter antacids, which work by neutralizing acid in the stomach, or medications that stop acid production.

Antacids, such as Maalox, Mylanta, Tums, and Rolaids are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts -- magnesium, calcium, and aluminum -- with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

H2 blockers, such as Tagamet, Pepcid, Axid, and Zantac, impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers shouldn't be used for more than a few weeks at a time. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor. H2 blockers shouldn't be used for more than a few weeks at a time without evaluation by a doctor.

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. Proton pump inhibitors also shouldn't be used for more than a few weeks at a time without evaluation by a doctor.


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. 11 Dec 2007.

"Omeprazole for Nonerosive Reflux Disease." Journal Watch Gastroenterology. 11 Dec 2007.

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