Differentiating NERD from Functional Heartburn

D Patel et al. Clin Gastroenterol Hepatol 2021; 19: 1314-26. Full text: Untangling Nonerosive Reflux Disease From Functional Heartburn. This is an excellent review.

Key points:

  • PPI response: 56% for erosive reflux disease, 37% for NERD, and 25% for functional heartburn (FH) per Figure 3 (*”FH might be a placebo effect owing to short follow-up evaluation”
  • Determination of abnormal acid exposure time (AET >6% in adults) is key in distinguishing NERD from FH which in turn helps with selection of treatment. NERD is notable for AET >6% in adults. Many patients with NERD may also have esophageal hypersensitivity
  • Table 2 reviews efficacy of neuromodulators for functional esophageal disorders; these include TCAs, SNRIs, SSRIs, and other agents (eg. gabapentin)
Heartburn etiologies in adults, per Yamasak T et al. J Neurogastroenterol Motil 2017; 23: 495-503.

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