Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis.

• Abstract: BACKGROUND & AIMS: It has been postulated that nonerosive reflux disease (NERD) and erosive reflux disease (ERD) are 2 distinct entities of gastroesophageal reflux disease. The aim of this study was to compare the clinical characteristics between patients with NERD and those with ERD. METHODS: We prospectively recruited consecutive patients presenting with weekly attacks of heartburn or acid regurgitation. Exclusion criteria included gastric surgery, recent use of nonsteroidal anti-inflammatory drug or proton pump inhibitor, and peptic ulcer disease. Concomitant functional dyspepsia, irritable bowel syndrome, and psychological disorders were documented. Endoscopy, esophageal manometry, acid perfusion test, and 24-hour ambulatory pH monitoring were performed. Risk factors of NERD were determined by multivariate analysis. RESULTS: Two hundred fourteen patients (NERD, 113; ERD, 111) were studied. NERD patients were characterized by higher prevalence of Helicobacter pylori (36.3% vs 18%, P = .005), functional dyspepsia (64.6% vs 42.3%, P = .003), irritable bowel syndrome (44.2% vs 15.3%, P < .001), psychological disorders (9% vs 0.9%, P = .04), and positive acid perfusion test (40.7% vs 19.8%, P = .004). ERD patients had more hiatal hernias (35.1% vs 17.1%, P = .009), higher esophageal acid exposure (total time esophageal pH <4, 4.2% +/- 2.1% vs 5.9% +/- 2.3%; P = .01), and esophageal dysmotility (P < .05). With multivariate analysis, H pylori (odds ratio, 1.8; 95% confidence interval [CI], 1.1-3.2), irritable bowel syndrome (odds ratio, 2.8; 95% CI, 1.6-5.3), and positive acid perfusion test (odds ratio, 1.9; 95% CI, 1.4-2.8) were independent risk factors for NERD. CONCLUSIONS: Patients with NERD and ERD have distinct differences in clinical characteristics. NERD is characterized by higher prevalence of functional gastrointestinal disorders and esophageal acid hypersensitivity.
• Authors: Justin C Y Wu, Carrian M Y Cheung, Vincent W S Wong, Joseph J Y Sung (Affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong. justinwu at cuhk.edu.hk)
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 5 Issue 6 Pg. 690-5 (Jun 2007) ISSN: 1542-7714 [Electronic] United States
• PMID: 17481961 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Oncogene Proteins v-sis

Topics

• Adult
• Body Mass Index
• Esophagitis, Peptic (diagnosis, epidemiology)
• Esophagoscopy
• Female
• Gastroesophageal Reflux (diagnosis, epidemiology)
• Humans
• Hydrogen-Ion Concentration
• Irritable Bowel Syndrome (epidemiology)
• Male
• Manometry
• Middle Aged
• Multivariate Analysis
• Oncogene Proteins v-sis
• Prospective Studies
• Risk Factors