Non-erosive Reflux Disease (NERD), Symptomatic and Asymptomatic Erosive Reflux Disease (ERD): From Hypersensitive to Hyposensitive Esophagus

Aims To compare the esophageal sensitivity to acid and saline in patients with symptomatic and asymptomatic erosive reflux disease (ERD), non-erosive reflux disease (NERD) and controls, and to assess the response to proton-pump inhibitors in patients with symptomatic ERD and NERD. Methodology Patients with GERD and a control group of healthy asymptomatic volunteers were recruited. All subjects underwent esophagogastroduodenoscopy and the acid-saline perfusion test. Symptomatic ERD and NERD patients were given rabeprazole 20 mg twice daily for 2 weeks and their response to treatment assessed. Results A total of 105 subjects were recruited: ERD = 37 (symptomatic = 24, asymptomatic = 13), NERD = 34 and controls = 34. During saline perfusion, only the NERD group recorded a significantly higher sensitivity score compared to controls (2.74 +/- 7.28 vs. 0) (p = 0.035). During acid perfusion, symptomatic ERD (15.42 +/- 13.42) and NERD (16.71 +/- 15.04) had significantly higher scores versus controls and asymptomatic ERD patients (both p < 0.001). The mean %Delta reflux symptom score following treatment was significantly higher in symptomatic ERD patients compared to NERD patients (89.08 +/- 21.67 vs. 58.53 +/- 32.54; p < 0.001). Conclusions Patients with NERD were a generally hypersensitive group while asymptomatic ERD patients represent a hyposensitive group of patients which merits further study.