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

• DOI: 10.1007/s10620-010-1275-5
• Publication Date: 2010-05-13T20:28:06Z
• Authors: Juanda L. Hartono; Choon-Seng Qua; Khean-Lee Goh
• Keywords: Adult; Male; 0301 basic medicine; Proton Pump Inhibitors; Middle Aged; Sodium Chloride; 2-Pyridinylmethylsulfinylbenzimidazoles; 3. Good health; 03 medical and health sciences; Treatment Outcome; Case-Control Studies; Rabeprazole; Disease Progression; Gastroesophageal Reflux; Hypersensitivity; Humans; Female; Hydrochloric Acid; Aged

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.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.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 %∆ 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).Patients with NERD were a generally hypersensitive group while asymptomatic ERD patients represent a hyposensitive group of patients which merits further study.