Endoscopy-Negative Reflux Disease

Contributor: Dr. A Jain

Gastroesophageal reflux disease (GERD) is a common condition. The term "gastroesophageal reflux disease" is defined to include all individuals who are exposed to the risk of physical complications from GERD, (such as damage to the esophagus) or who experience clinically significant impairment of health related well-being (quality of life) due to reflux related symptoms.

The prevalence and impact of GERD on society is dramatic. Symptoms of GERD, such as heartburn and acid regurgitation, occur monthly in 36%, weekly in 20%, and daily in 10% of the adult population. GERD patients have reported significantly worse scores in termsa of their physical function and well being, and emotional well being compared with the general population. Patients with GERD also experience worse emotional well-being than patients with two other common conditions, diabetes and hypertension. Of all major gastrointestinal disease, GERD represents the greatest financial burden, with a total cost of $10.1 billion annually in the United States.

One of the most common ways to investigate for GERD and/or its complications is by upper endoscopy examination. Complications that may arise from chronic GERD include inflammation, ulceration, stricture and also a pre-malignant condition of the esophagus, namely Barrett's esophagus. Until recently, the understanding and focus of GERD was largely limited to patients with such complications. However, erosions or ulcers in the esophageal mucosa occur in fewer than 30% of patients at endoscopy.

Endoscopic-negative reflux disease (ENRD) therefore, represents an enormously important clinical problem that has received considerable attention in recent years. Several large studies of patients with reflux symptoms have shown that between half and two-thirds of patients are endoscopy-negative. Surmounting data has shown that the greatest impact of GERD is on quality of life, (a measure used to evaluate the impact on social, psychological and physical functioning in everyday life), and that the impairment is similar in patients with and without esophageal erosive disease. Furthermore, successful treatment of GERD results in improvement in health-related quality of life. Therefore, symptom relief is a clinically more relevant outcome than endoscopic healing.

The treatment of patients with ENRD is based on similar principles to those currently recommended for erosive and ulcerative esophagitis, except that the primary objective is the relief of symptoms. Numerous randomized controlled trials have been conducted examining symptomatic relief in treating ENRD patients with anti-secretory agents (ie. histamine-receptor antagonists and proton-pump inhibitors). However, there is increasing data suggesting that patients with ENRD may require higher doses of anti-secretory agents compared to patients with erosive disease, to relieve symptoms.

Past reports

Gastric Adenocarcinoma and Helicobactor pylori

Press Release: NEXIUM®- Now Available in Canada

Non-ulcer Dyspepsia and Helicobacter Pylori Infection: To Treat or Not to Treat

Gastroesophageal Reflux Disease in Pregnancy

Top