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Non-erosive reflux disease (NERD)Non-erosive reflux disease (NERD) is a condition characterized by reflux symptoms such as heartburn and regurgitation without esophageal mucosal break. Some patients with NERD are considered to have the mild type of reflux esophagitisReflux esophagitis. However, other patients have different pathophysiologies that cannot be explained by the mild type of reflux esophagitis. According to the Rome IV criteria, NERD is classified into the following types. One type is narrowly defined or true NERD in which acid exposure in the esophagus is excessive. Another type is reflux hypersensitivityReflux hypersensitivity in which acid exposure in the esophagus is normal but symptoms are related to reflux (mainly weakly acidic reflux) due to esophageal hypersensitivity. The third type of NERD is functional heartburnFunctional heartburn in which acid exposure in the esophagus is normal and symptoms are unrelated to reflux. Approximately half of the patients with NERD are resistant to proton pump inhibitor (PPI) therapy. In PPI-resistant patients, mosapride, acotiamide, rikkunshito, or alginate are additionally administered (off-label use for NERD). Providing adequate explanations to reassure patients and establish a good patient–physician relationship and considering evaluating pathophysiology at a specialized institution for refractory patients are important. Anti-reflux surgery is an option of treatment for patients with reflux-related symptoms.

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Diagnosis and Treatment of Motility Disorder of the Esophagus, Non-Erosive Reflux Disease (Including Reflux Hypersensitivity)

  • 章节

  • 发表日期：

    2026年

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  • Noriyuki Kawami,
  • Katsuhiko Iwakiri

摘要

Non-erosive reflux disease (NERD)Non-erosive reflux disease (NERD) is a condition characterized by reflux symptoms such as heartburn and regurgitation without esophageal mucosal break. Some patients with NERD are considered to have the mild type of reflux esophagitisReflux esophagitis. However, other patients have different pathophysiologies that cannot be explained by the mild type of reflux esophagitis. According to the Rome IV criteria, NERD is classified into the following types. One type is narrowly defined or true NERD in which acid exposure in the esophagus is excessive. Another type is reflux hypersensitivityReflux hypersensitivity in which acid exposure in the esophagus is normal but symptoms are related to reflux (mainly weakly acidic reflux) due to esophageal hypersensitivity. The third type of NERD is functional heartburnFunctional heartburn in which acid exposure in the esophagus is normal and symptoms are unrelated to reflux. Approximately half of the patients with NERD are resistant to proton pump inhibitor (PPI) therapy. In PPI-resistant patients, mosapride, acotiamide, rikkunshito, or alginate are additionally administered (off-label use for NERD). Providing adequate explanations to reassure patients and establish a good patient–physician relationship and considering evaluating pathophysiology at a specialized institution for refractory patients are important. Anti-reflux surgery is an option of treatment for patients with reflux-related symptoms.