Overview.
The exact term for non-erosive reflux disease is non-erosive gastroesophageal reflux disease (NERD), which refers to a disease in which the stomach (including duodenal contents) refluxes into the esophagus, causing reflux, heartburn, etc., without esophageal mucosal rupture or Barrett’s esophagus manifestations. Most scholars believe that abnormal esophageal contractile function, increased esophageal sensitivity, and mental factors are related to the development of this disease. Non-erosive reflux disease is now mostly treated with medication.
Questions you may be concerned about
What is non-celiac reflux disease?
Non-erosive reflux disease (NERD) is a kind of gastroesophageal reflux disease (GERD), which is a condition in which the contents of the gastroduodenum reflux into the esophagus, causing symptoms such as heartburn, but there are no erosions and ulcers of the esophageal mucosa under gastroscopy.
1. Etiology and mechanism: It is the reflux of gastric acid, pepsin and bile, etc. Due to the anti-reflux mechanism, such as the damage of the structure of the lower esophageal sphincter, the decrease of esophageal clearing effect, the decrease of the barrier function of the esophageal mucosa, etc., the esophageal mucosa is stimulated and the corresponding symptoms are caused.
2. Clinical manifestations:Typical symptoms are heartburn and reflux, followed by chest pain, dysphagia, retrosternal foreign body sensation, and extra-esophageal symptoms, such as pharyngolaryngitis, chronic cough and asthma.
3. Examination:Gastroscopy is the most accurate method to diagnose non-erosive reflux disease, in addition, there are 24-hour esophageal pH monitoring, esophageal X-ray barium meal, esophageal manometry and so on.
4. Treatment:It mainly includes medication, such as drugs to promote gastric motility, domperidone, etopride; acid-suppressing drugs, such as omeprazole, ranitidine, etc.; surgical treatment, anti-reflux surgery for patients with severe respiratory diseases caused by reflux, and scar resection for patients with severe esophageal stenosis; and patient education, such as avoidance of obesity and high-fat diet.
Therefore, patients with non-celiac reflux disease should actively seek medical attention and early treatment to avoid delay.
Etiology
1. Increased esophageal sensitivity and mental factors
Visceral hypersensitivity may be one of the main causes of chest pain in non-celiac reflux disease. Psycho-spiritual factors play an important role in the development of non-celiac reflux disease.
2. Abnormal esophageal contractile function and reflux
Lower esophageal sphincter dysfunction is one of the most important reasons for the development of non-celiac reflux disease.
3. Esophageal mucosal barrier dysfunction
Esophageal mucosal epithelial cell gap is widened, and the reflux material acts on the mucosal nerve endings through the widened cell gap.
Symptoms
The typical symptom of this disease is heartburn, which may or may not be combined with acid reflux. If acid reflux occurs, there is a burning sensation behind the sternum (heartburn) and chest pain. Heartburn is a burning sensation radiating from the back of the sternum to the neck. Acid reflux occurs most often after a full meal and interferes with the patient’s sleep at night when reflux is severe.
Examination
1. Endoscopy and esophageal mucosal biopsy
(1) The main purpose of endoscopy is to exclude erosive esophagitis and ulceration, etc. Biopsy of the distal esophageal mucosa can reveal some typical histologic changes of reflux, such as infiltration of epithelial cells and eosinophils, basal cell proliferation and prolongation of papillary muscles. However, no damage to the esophageal mucosa was observed endoscopically.
(2) The most sensitive indicator of mucosal biopsy is widening of the cell gap, in addition to papillary hyperplasia, thickening of the basal cell layer and cellular infiltration.
2. 24-hour esophageal pH monitoring
24-hour esophageal pH monitoring is one of the most important tests for the diagnosis of non-erosive reflux disease, which is helpful in the diagnosis.
Diagnosis
1. The diagnosis of non-erosive reflux disease is mainly based on symptomatology. Its most prominent symptom is heartburn, which may or may not be combined with reflux.
2. Endoscopy does not show any esophageal mucosal lesions, and a biopsy of the esophageal mucosa reveals a widening of the cell gap, which can be diagnosed when combined with pH monitoring.
Treatment
The aim of treatment for non-celiac reflux disease is to relieve symptoms, improve quality of life and prevent respiratory complications.
1. General treatment
Lifestyle changes are the basic measures of treatment. Elevating the head of the bed by 15 to 20 centimeters is a simple but effective way to reduce nocturnal reflux by using gravity to enhance acid clearance during sleep. It is advisable to appropriately limit the intake of foods such as fat, chocolate, tea and coffee. GERD patients should quit smoking and drinking. Avoiding a full stomach 3 hours before bedtime can likewise reduce nocturnal reflux. Some patients’ symptoms may improve after changing the above habits.
2. Drug treatment
Currently, drug therapy is the mainstay of treatment for non-erosive reflux disease. Pharmacological treatment includes H2 receptor antagonists, proton pump inhibitors and agonists.
Prevention
1. Excessive obesity will increase the abdominal pressure and contribute to reflux, so the intake of high-fat food that promotes reflux should be avoided, and the weight should be reduced. 2. Avoiding all kinds of movements and postures that increase the abdominal pressure for a long time in life, including wearing tight clothes and tightening the waistband, can help prevent reflux.