How to Treat Nonerosive Reflux Disease (NERD)

A type of GERD that shows no visible damage to the esophagus.

Reflux disease
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Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES) does not close properly, so stomach contents leak back, or reflux, into the esophagus.

For some patients, GERD can cause erosive esophagitis, a condition that causes inflammation, erosions, and ulcers to form in the esophagus. Erosive esophagitis can be seen with an endoscope—an instrument with a light and a camera on it that allows a doctor to visualize a person's digestive system.

 

But many people actually have what is called nonerosive reflux disease, or NERD. With NERD, people experience typical GERD symptoms caused by acid reflux, but they do not have any visible esophageal injury.

Treatment for NERD is similar to that for erosive GERD. Depending on the severity of symptoms, treatment may involve one or more of the following: lifestyle changes, medications, or surgery.

Lifestyle Changes to Treat NERD

According to the American College of Gastroenterology, lifestyle habits are a component of managing acid reflux disease.

Weight Loss: One of the strongest recommendation is with regards to a person's weight. If you are overweight or obese (which means a body mass index of greater than 25), or if you have recently gained weight, weight loss is strongly recommended. The science behind this is that extra weight along your waistline can increase abdominal pressure, which can then push stomach contents up into the esophagus.

Other lifestyle recommendations include elevating the head of your bed, especially if your symptoms of reflux are worse at night and/or wake you up at night.

Stopping smoking and drinking alcohol may also be helpful,  although this change has not been conclusively proven in scientific studies to help with GERD symptoms.

Still, many doctors will recommend it on an individual basis.

Eliminating certain foods can also be helpful for managing symptoms of acid reflux, especially chocolate, caffeine, spicy foods, citrus, and carbonated drinks. This change can be particularly useful in people who note a link between their symptoms and one or more specific foods. 

Finally, eating small meals (as large meals may increase upward pressure against the esophageal sphincter) and avoiding eating meals at least two to three hours before going to bed or reclining may also be helpful.

Medications to Treat NERD

Your doctor may recommend over-the-counter antacids, which work by neutralizing acid in the stomach, or medications that stop acid production.

Antacids, such as Maalox, Mylanta, Tums, and Rolaids are usually the first drugs recommended relieving heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts —magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach.

The downside is that antacids have some potential side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

H2 blockers, such as Tagamet, Pepcid, Axid, and Zantac, impede acid production. They are available in prescription strength and over-the-counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time without the proper guidance of a doctor.

Proton pump inhibitors include Prilosec, Prevacid, Protonix, Aciphex, and Nexium, which are all available by prescription. Prilosec is available in an over-the-counter form (Prilosec OTC). Proton pump inhibitors (PPIs) are a group of medications that prevent the release of acid in the stomach and intestines.

Proton pump inhibitors also should not be used for more than a few weeks at a time without guidance from a doctor.

Surgery to Treat NERD

According to the American College of Gastroenterology, surgical choices for people with GERD include laparoscopic fundoplication or bariatric surgery in a person who is obese. In a laparoscopic fundoplication, the upper region of the stomach is wrapped around the lower part of the esophagus.

The decision to undergo surgery is a complicated one and requires thoughtful discussions between a person and his or her doctors. 

Sources:

Hershcovici T, Fass R. Nonerosive Reflux Disease (NERD) - An Update. J Neurogastroenterol Motil. 2010 Jan;16(1):8-21.

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-28.

Kahrilas PJ. (March 2016). Medical management of gastroesophageal reflux disease in adults. In: UpToDate, Talley NJ (Ed), UpToDate, Waltham, MA. 

Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy-negative reflux disease. Cochrane Database Syst Rev. 2013 May 31;(5):CD002095.

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