Overview of the Types of GERD

The types are based on what your doctor can see with an endoscope.

Gastroesophageal reflux disease (GERD), also known as acid reflux disease, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus causing symptoms like heartburn, problems swallowing, and/or regurgitation.

While many people have heard of the terms acid reflux, heartburn, or GERD, which are often used interchangeably, some confusion may arise when your doctor specifies a certain type of GERD or complication related to your GERD.

Let's clarify these terms below so you can properly care for your esophageal health. 

Types of GERD

There are two types of GERD, and they are distinguished based on the appearance of the inner lining of the esophagus (called the mucosa). The mucosa can only be visualized by an upper endoscopy—a procedure performed by a gastroenterologist

Erosive Esophagitis

A person with erosive esophagitis has inflammation, swelling, and visible breaks and ulcers within the mucosa of the esophagus. The key element of erosive esophagitis is that it can be diagnosed even when a person is not having any bothersome symptoms of GERD. In these cases, the endoscope may have been done for another purpose, and the erosions in the esophagus are seen incidentally.

That being said, if a person has symptoms, they may include heartburn, regurgitation, problems swallowing, or painful swallowing—those typical of GERD. 

Erosive esophagitis is treated with a proton pump inhibitor.

Usually a person can ween off the medication,  unless they have severe esophagitis, continue to have symptoms, or have other complications. 

Nonerosive Reflux Disease (NERD)
A person has NERD when they have symptoms of GERD (for example, heartburn and trouble swallowing) but there is zero evidence of any injury or breaks to the esophageal mucosa.

Like erosive esophagitis, a doctor will treat a person, but management varies depending on the severity and frequency of that person's symptoms.

Typical treatment of NERD includes lifestyle modifications like weight loss and elevation of the bed and often an acid-blocking medication like an H2 Blocker or a proton pump inhibitor.

Other Terms Sometimes Used When Describing GERD

Sometimes doctors use other terms to further define a person's GERD, like when describing how a person is responding the GERD therapy or a complication of GERD itself. 

​​Refractory Gastroesophageal Reflux Disease (Refractory GERD)

The term refractory gastroesophageal reflux disease (refractory GERD) describes people who continue to have symptoms of gastroesophageal reflux despite standard treatment with proton pump inhibitors (PPIs). It can also be used to describe people who continue to have evidence of esophageal inflammation (seen on an endoscope) despite therapy with a proton pump inhibitor. 

Larygopharyngeal Reflux (LPR)
When the lower esophageal sphincter (LES) is not functioning properly, there is a back flow of stomach acid into the esophagus, which can lead to GERD. Sometimes the stomach contents also come into contact with and injure the mucosa of the pharynx (your throat) and larynx (your voicebox)—this is called laryngopharyngeal reflux.

With LPR, a person may develop symptoms like hoarseness, cough, throat clearing, a feeling like there is something in their throat, or a choking sensation. 

Sources:

Katz, P.O., Gerson, L.B., Vela M.F. Guidelines for the diagnosis and management of gastroesophageal reflux disease.Am J Gastroenterol. 2013 Mar;108(3):308-28.

Kahrilas, PJ. (February 2015). Complications of gastroesophageal reflux in adults. In: UpToDate, Talley NJ (Ed), UpToDate, Waltham, MA. 

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