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Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis.
Clin Gastroenterol Hepatol. 2007 Jun; 5(6):690-5.CG

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+Show Affiliations

Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong. justinwu@cuhk.edu.hkNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17481961

Citation

Wu, Justin C Y., et al. "Distinct Clinical Characteristics Between Patients With Nonerosive Reflux Disease and Those With Reflux Esophagitis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 5, no. 6, 2007, pp. 690-5.
Wu JC, Cheung CM, Wong VW, et al. Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis. Clin Gastroenterol Hepatol. 2007;5(6):690-5.
Wu, J. C., Cheung, C. M., Wong, V. W., & Sung, J. J. (2007). Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 5(6), 690-5.
Wu JC, et al. Distinct Clinical Characteristics Between Patients With Nonerosive Reflux Disease and Those With Reflux Esophagitis. Clin Gastroenterol Hepatol. 2007;5(6):690-5. PubMed PMID: 17481961.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis. AU - Wu,Justin C Y, AU - Cheung,Carrian M Y, AU - Wong,Vincent W S, AU - Sung,Joseph J Y, Y1 - 2007/05/04/ PY - 2007/5/8/pubmed PY - 2007/12/6/medline PY - 2007/5/8/entrez SP - 690 EP - 5 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 5 IS - 6 N2 - 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. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/17481961/Distinct_clinical_characteristics_between_patients_with_nonerosive_reflux_disease_and_those_with_reflux_esophagitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00216-9 DB - PRIME DP - Unbound Medicine ER -