Review

Diagnosis and Management of Non-Erosive Reflux Disease – The Vevey NERD Consensus Group
I.M. Modlin^a, R.H. Hunt^b, P. Malfertheiner^c, P. Moayyedi^b, E.M. Quigley^d, G.N.J. Tytgat^e, J. Tack^f, R.C. Heading^g, G. Holtman^h, S.F. Mossⁱ, on behalf of the Vevey NERD Consensus Group

^aYale University, New Haven, Conn., USA;
^bMcMaster University Health Science Centre, Hamilton, Ont., Canada;
^cOtto von Guericke University, Magdeburg, Germany;
^dUniversity College, Cork, Ireland;
^eUniversity of Amsterdam, Amsterdam, The Netherlands;
^fUniversity Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium;
^gDepartment of Gastroenterology, Royal Infirmary, Glasgow, UK;
^hUniversity of Adelaide, Adelaide, S.A., Australia;
ⁱRhode Island Hospital and Brown University, Providence, R.I., USA

Address of Corresponding Author

Digestion 2009;80:74-88 (DOI: 10.1159/000219365)

  Key Words

• Delphi method
• Gastro-esophageal reflux disease
• NERD, clinical features
• NERD, definition
• NERD, diagnosis and treatment
• NERD, disease assessment
• Non-erosive reflux disease (NERD)
• Vevey NERD Consensus Group

  Abstract

Background/Aims: Although considerable information exists regarding gastroesophageal reflux disease with erosions, much less is known of non-erosive reflux disease (NERD), the dominant form of reflux disease in the developed world. Methods: An expert international group using the modified Delphi technique examined the quality of evidence and established levels of agreement relating to different aspects of NERD. Discussion focused on clinical presentation, assessment of clinical outcome, pathobiological mechanisms, and clinical strategies for diagnosis and management. Results: Consensus was reached on 85 specific statements. NERD was defined as a condition with reflux symptoms in the absence of mucosal lesions or breaks detected by conventional endoscopy, and without prior effective acid-suppressive therapy. Evidence supporting this diagnosis included: responsiveness to acid suppression therapy, abnormal reflux monitoring or the identification of specific novel endoscopic and histological findings. Functional heartburn was considered a separate entity not related to acid reflux. Proton pump inhibitors are the definitive therapy for NERD, with efficacy best evaluated by validated quality-of-life instruments. Adjunctive antacids or H₂ receptor antagonists are ineffective, surgery seldom indicated. Conclusions: Little is known of the pathobiology of NERD. Further elucidation of the mechanisms of mucosal and visceral hypersensitivity is required to improve NERD management.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Irvin M. Modlin, MD, PhD
Department of Gastroenterological Surgery, Yale University School of Medicine
PO Box 208062, New Haven, CT 06520-8062 (USA)
Tel. +1 203 785 5429, Fax +1 203 737 4067
E-Mail imodlin@optonline.net

  Article Information

The Vevey NERD Consensus Group: David Armstrong, Qasim Aziz, Michele Cicala, Hashem El-Serag, Gary Falk, Roberto Fiocca, Kwong Ming Fock, Michael Fried, Khean-Lee Goh, Robert Heading, Gerald Holtmann, Pali Hungin, Richard Hunt, Vladimir Ivashkin, Peter Kahrilas, Peter Katelaris, Peter Malfertheiner, Kenneth McColl, Paul Moayyedi, Irvin Modlin, Steven Moss, Roy Orlando, Thierry Piche, Joaquim Prado Pinto des Moraes-Filho, Eamonn Quigley, Greg Rubin, Reza Shaker, Daniel Sifrim, Andre Smout, Jose Sollano, Vincenzo Stanghellini, Joseph Sung, Jan Tack, Alexander Trukhmanov, Guido Tytgat, Michael Vieth.

Published online: June 17, 2009
Number of Print Pages : 15
Number of Figures : 0, Number of Tables : 0, Number of References : 94