Non-erosive reflux disease: part of the spectrum of gastro-oesophageal reflux disease, a component of functional dyspepsia, or both?

Over the last several decades, the incidences of gastric cancer and peptic ulcer have declined while the incidences of gastro-oesophageal reflux disea se (GORD) and functional dyspepsia have reached virtually epidemic proporti ons. A similar trend is occurring in oesophageal cancer, with squamous cell carcinoma on the decline and adenocarcinoma on the rise, possibly due to t he dramatic increase in GORD. The true clinical spectrum of these disorders , however, is only recently becoming evident: 60% of patients with GORD do not have detectable evidence of oesophagitis; they can be classified as hav ing non-erosive or negative-endoscopy reflux disease (NERD). In this sub-gr oup, a significant proportion will also manifest normal acid exposure on 24 -h pH monitoring. Further, patients with NERD appear to be somewhat less re sponsive to gastric acid suppression with proton pump inhibitors. These dif ferences, combined with the concept of the 'tender' oesophagus and the freq uent presence of dyspeptic symptoms in patients with NERD, have important t herapeutic implications, Therefore, considering the marked overlap in these disorders, is it realistic or clinically relevant to distinguish the entit ies of GORD, NERD, and functional dyspepsia? This dilemma has led to genera l guidelines: should heartburn predominate, treat as GORD; if dyspepsia pre dominates, treat as functional dyspepsia, In practical terms, each diagnosi s requires consideration of the other. Eur J Gastroenterol Hepafol 73 (supp l 1): S13-S18 (C) 2001 Lippincott Williams & Wilkins.