The majority of patients with symptoms of gastro-oesophageal reflux have no
endoscopic evidence of oesophagitis. There has been remarkably little syst
ematic gathering of information about this group of patients. It is commonl
y believed that they have a mild form of reflux disease, with low levels of
dysfunction that usually respond to simple therapeutic measures. Emerging
data from recent studies indicate that this is not the case. Endoscopy-nega
tive patients have symptom severities comparable to those with erosive dise
ase, and which significantly impair their quality of life. The limited data
available on the pathophysiology of endoscopy-negative reflux disease sugg
est that, in the majority of patients, it is as much a disease of excessive
gastro-oesophageal reflux as it is in patients with oesophageal lesions. T
he same principles that apply to successful treatment in patients with oeso
phagitis also hold true for patients with endoscopy-negative disease.