Z Gastroenterol 2007; 45(11): 1156-1163
DOI: 10.1055/s-2007-963628
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Non-Erosive Reflux Disease (NERD) and Erosive Esophagitis - a Spectrum of Disease or Special Entities?

Nicht-erosive Refluxerkrankung (Non-erosive Reflux Disease, NERD) und erosive Ösophagitis - ein Krankheitsspektrum oder verschiedene Erscheinungsbilder derselben Krankheit?R. Fass1
  • 1The Neuroenteric Clinical Research Group, Section of Gastroenterology, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona USA
Further Information

Publication History

manuscript received: 17.7.2007

manuscript accepted: 9.10.2007

Publication Date:
19 November 2007 (online)

Zusammenfassung

Das Verständnis der natürlichen Geschichte der gastroösohagealen Refluxerkrankung (reflux oesophagitis oder Gastroesophageal Reflux Disease, GERD) hat eine bedeutende Auswirkung auf die langfristige Behandlung der Krankheit. Wenn man die momentan zur Verfügung stehenden Studien bezüglich des natürlichen Verlaufs der GERD auswertet, zeigt sich, dass die GERD derzeit in drei verschiedene Phänotypen aufgeteilt wird. Zudem teilt sich das Forschungsfeld momentan in zwei verschiedene Lager, die sich entweder für oder gegen einen Paradigmenwechsel im natürlichen Verlauf der GERD aussprechen. Entsprechend der grössten (bezügl. der Population) und längsten Studien, die den natürlichen Verlauf der GERD untersuchten, wurde im Verlauf der Zeit nur bei 10 % der Patienten ein Fortschreiten von NERD zur erosiven Ösophagitis entdeckt. Der Großteil der GERD Patienten blieb jedoch im Rahmen seines jeweiligen phänotypischen Erscheinungsbildes der GERD.

Abstract

An understanding of the natural history of GERD has an important impact on the long-term management of the disorder. By assessing the currently available studies that evaluated the natural course of GERD, a new conceptual framework that suggests that GERD is composed of three distinct phenotypic presentations has been recently proposed. Presently, the field has been divided into two camps that support or oppose a paradigm shift in the natural course of GERD. Nevertheless, the largest population-based or longest duration natural course studies report only 10 % progress from NERD to erosive esophagitis over time. The other GERD patients remained within their respective phenotypic presentation of GERD.

References

  • 1 Fass R, Ofman J. Gastroesophageal reflux disease - should we adopt a new conceptual framework?.  Am J Gastroenterol. 2002;  97 1901-1909
  • 2 Fass R. Gastroesophageal reflux disease revisited.  Gastroenterol Clin North Am. 2002;  31 S1-S10
  • 3 Fass R. Distinct phenotypic presentations of gastroesophageal reflux disease: a new view of the natural history.  Dig Dis. 2004;  22 100-107
  • 4 Pace F, Bianchi Porro G. Gastroesophageal reflux disease: A typical spectrum disease (a new conceptual framework is not needed).  Am J Gastroenterol. 2004;  99 946-949
  • 5 Quigley E. Non-erosive reflux disease: a part of the spectrum of gastro-oesophageal reflux disease, a component of functional dyspepsia, or both?.  Eur J Gastroenterol Hepatol. 2001;  13 (Suppl 1) S13-18
  • 6 Agrawal A, Castell D. GERD is chronic but not progressive (editorial).  J Clin Gastroenterol. 2006;  40 374-375
  • 7 Spechler S, Goyal R. Barrett’s esophagus.  N Engl J Med. 1986;  315 362-371
  • 8 Labenz J, Jaspersen D, Kulig M. et al . Risk factors for erosive esophagitis: a multivariate analysis based on the ProGERD study initiative.  Am J Gastroenterol. 2004;  99 1652-1656
  • 9 Fass R, Fennerty M, Vakil N. Nonerosive reflux disease - current concepts and dilemmas.  Am J Gastroenterol. 2001;  96 303-314
  • 10 Chiba N, De Gara C, Wilkinson J. et al . Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis.  Gastroenterology. 1997;  117 1798-1810
  • 11 Richter J, Peura D, Benjamin S. et al . Efficacy of omeprazole for the treatment of symptomatic acid reflux disease without esophagitis.  Arch Intern Med. 2000;  160 1810-1816
  • 12 Kaltenbach T, Crockett S, Gerson L. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach.  Arch Intern Med. 2006;  166 965-971
  • 13 Hanna S, Rastogi A, Weston A. et al . Detection of Barrett’s esophagus after endoscopic healing of rrosive esophagitis.  Am J Gastroenterol. 2006;  101 1416-1420
  • 14 Pace F, Bollani S, Molteni P. et al . Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD) - a reappraisal 10 years on.  Dig Liver Dis. 2004;  36 111-115
  • 15 Pace F, Pallotta S, Molteni P. et al . Natural history of NERD in 3 Italian tertiary referral centres after 5 years of follow-up.  Gut. 2006;  55 (Suppl 5) A62
  • 16 Shapiro M, Green C, Faybush E. et al . The extent of oesophageal acid exposure overlap among the different gastro-oesophageal reflux disease groups.  Aliment Pharmacol Ther. 2006;  23 321-329
  • 17 Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): Comparison of epidemiologic, physiologic, and therapeutic characteristics.  J Clin Gastroenterol. 2007;  41 131-137
  • 18 Pace F, Santalucia F, Bianchi Porro G. Natural history of gastro-oesophageal reflux disease without oesophagitis.  Gut. 1991;  32 845-848
  • 19 Kuster E, Ros E, Toledo-Pimentel V. et al . Predictive factors of the long term outcome in gastro-oesophageal reflux disease: six year follow up of 107 patients.  Gut. 1994;  35 8-14
  • 20 Isolauri J, Luostarinen M, Isolauri E. et al . Natural course of gastroesophageal reflux disease: 17 - 22 year follow-up of 60 patients.  Am J Gastroenterol. 1997;  92 37-41
  • 21 McDougall N, Johnston B, Kee F. et al . Natural history of reflux oesophagitis: a 10 year follow up of its effect on patient symptomatology and quality of life.  Gut. 1996;  38 481-486
  • 22 McDougall N, Johnston B, Collins J. et al . Disease progression in gastro-oesophageal reflux disease as determined by repeat oesophageal pH monitoring and endoscopy 3 to 4.5 years after diagnosis.  Eur J Gastroenterol Hepatol. 1997;  9 1161-1167
  • 23 Manabe N, Yoshihara M, Sasaki A. et al . Clinical characteristics and natural history of patients with low-grade reflux esophagitis.  J Gastroenterol Hepatol. 2002;  17 949-954
  • 24 Labenz J, Nocon M, Lind T. et al . Prospective follow-up data from the ProGERD study suggest that GERD is not a categorical disease.  Am J Gastroenterol. 2006;  101 2457-2462
  • 25 Willich S, Nocon M, Kulig M. et al . Cost-of-disease analysis in patients with gastro-oesophageal reflux disease and Barrett’s mucosa.  Aliment Pharmacol Ther. 2006;  23 371-376
  • 26 Garrido Serrano A, Guerrero Igea F, Lepe Jiménez J . et al . Clinical features and endoscopic progression of gastroesophageal reflux disease.  Rev Esp Enferm Dig (Madrid). 2003;  95 712-716
  • 27 Sontag S, Sonnenberg A, Schnell T. et al . The long-term natural history of gastroesophageal reflux disease.  J Clin Gastroenterol. 2006;  40 398-404
  • 28 Bardhan K, Royston C, Nayyar A. Reflux rising! An essay on witnessing a disease in evolution.  Dig Liver Dis. 2006;  38 163-168
  • 29 Fass R, Sampliner R. Barrett’s oesophagus: optimal strategies for prevention and treatment.  Drugs. 2003;  63 555-564
  • 30 Sampliner R, Fennerty M, Garewal H. Reversal of Barrett’s esophagus with acid suppression and multipolar electrocoagulation: preliminary results.  Gastrointest Endosc. 1996;  44 532-535
  • 31 Goldman M, Beckman R. Barrett syndrome. Case report with discussion about concepts of pathogenesis.  Gastroenterology. 1996;  39 104-110
  • 32 Endo M, Kobayashi S, Kozu T. et al . A case of Barrett’s epithelialisation followed up for 5 years.  Endoscopy. 1974;  6 48-51
  • 33 Halvorsen J, Semb B. The “Barrett syndrome” (the columnar-lined lower esophagus): An acquired condition secondary to reflux esophagitis.  Acta Chir Scand. 1975;  141 683-687
  • 34 Cameron A, Arora A. Barrett’s esophagus and reflux esophagitis: is there a missing link?.  Am J Gastroenterol. 2002;  97 273-278
  • 35 Cameron A, Lomboy C. Barrett’s esophagus: age, prevalence, and extent of columnar epithelium.  Gastroenterology. 1992;  103 1241-1245
  • 36 Fitzgerald R, Onwuegbusi B, Bajaj-Elliott M. et al . Diversity in the oesophageal phenotypic response to gastro-oesophageal reflux: immunological determinants.  Gut. 2002;  50 451-459
  • 37 Fitzgerald R, Farthing M. The pathogenesis of Barrett’s esophagus: A process in continuum or discontinuum.  Curr Gastroenterol Rep. 2000;  2 421-424
  • 38 Stoltey J, Reeba H, Ullah P. et al . Does Barrett’s oesophagus develop over time in patients with chronic gastro-oesophageal reflux disease?.  Aliment Pharmacol Ther. 2007;  25 83-91
  • 39 Cameron A, Lagergren J, Henriksson C. et al . Gastroesophageal reflux disease in monozygotic and dizygotic twins.  Gastroenterology. 2002;  122 55-59
  • 40 Romero Y, Cameron A, Locke G. et al . Familial aggregation of gastroesophageal reflux in patients with Barrett’s esophagus and esophageal adenocarcinoma.  Gastroenterology. 1997;  113 1449-1456
  • 41 Quigley E. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.  Am J Gastroenterol. 2003;  98 S24-30
  • 42 Castell D, Kahrilas P, Richter J. et al . Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis.  Am J Gastroenterol. 2002;  97 575-583
  • 43 Hetzel D, Dent J, Reed W. et al . Healing and relapse of severe peptic esophagitis after treatment with omeprazole.  Gastroenterology. 1988;  95 903-912
  • 44 Sifrim D, Holloway R, Silny J. et al . Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings.  Gastroenterology. 2001;  120 1588-1598
  • 45 Fass R, Naliboff B, Higa L. et al . Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans.  Gastroenterology. 1988;  115 1363-1373
  • 46 Vela M, Camacho-Lobato L, Srinivasan R. et al . Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole.  Gastroenterology. 2001;  120 1599-606
  • 47 Wiklund I, Bardhan K, Muller-Lissner S. et al . Quality of life during acute and intermittent treatment of gastro-oesophageal reflux disease with omeprazole compared with ranitidine. Results from a multicentre clinical trial. The European Study Group.  Ital J Gastroenterol Hepatol. 1998;  30 19-27
  • 48 Stalhammer N, Carlsson J, Peacock R. et al . Cost effectiveness of omeprazole and ranitidine in intermittent treatment of symptomatic gastro-oesophageal reflux disease.  Pharmacoeconomics. 1999;  16 483-497
  • 49 Gerson L, Robbins A, Garbert A. et al . A cost-effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease.  Gastroenterology. 2000;  95 395-407
  • 50 Lind T, Havelund T, Carlsson R. et al . Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response.  Scand J Gastroenterol. 1997;  32 974-979
  • 51 Jones R, Hungin A, Phillips J. et al . Gastroesophageal reflux disease in primary care in Europe: Clinical presentation and endoscopic findings.  Eur J Gen Pract. 1995;  1 149-154
  • 52 Dean B, Gano Jr A, Knight K. et al . Effectiveness of proton pump inhibitors in nonerosive reflux disease.  Clin Gastroenterol Hepatol. 2004;  2 656-664

Professor Ronnie Fass, MD

The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, GI Section (1-111G-1), Internal Medicine, University of Arizona

3601 S.6th Avenue

Tucson

Arizona 85723-0001

USA

Phone: ++ 1/5 20/7 92 14 50

Fax: ++ 1/5 20/6 29 47 37

Email: Ronnie.fass@va.gov

    >