It is clear that acid-type pain without abnormal acid expostion is linked to an insufficient filtration of pain in the neuronal pathways. As a matter of fact, it is frequently associated with sternal allodynia, evidence of regional pain-filtration deficiency.

In my experience, it is linked to depression, like IBS.

It must be differenciated from acid pain without erosion but with abnormal acid expostion, which is explained by a unusually good resistance to acid corrosion.

As I see, your statement is based on article: World J Gastroenterol. 2011 July 21; 17(27): 3235–3241.

I think the parallels with IBS is very intriguing, because it is, indeed, bizarre that the same symptoms / GERD and NERD / have different endoscopic findings, as we see everyday in our gastroenterological practice. Obviously there are still unknown details regarding this issue

Thanks Izet, I hadn't seen that article but looking into the comorbidity of NERD and IBS is also interesting. I was surprised they still recommended PPI.

A little more off topic but still possibly connected- the upswing in non-celiac gluten intolerance diagnoses? Occupying the ground between the esophagus and the large intestine. This at least appears to have a treatable cause even if the mechanisms remain unknown.

NERD is a non-erosive pathological lesion of the esophagus. In such condition, there is enlargement of the intercellular spaces of the esiphageal mucosa and the gastroesophageal reflux is demonstrated by pHmetry and/or impedance. Although there also are important psychological features in this condition, NERD is a morphologic (or organic) disorder on the contraty of IBS which is a functional disorder. Many disorders may have points in common like NERD and IBS but they are different entities.

Thank you for this non-routine question!

There was an interesting article related to this question:

G.W. Friedland, Sh. Kohatsu, and Klaus Lewin / Comparative Anatomy of Feline and Canine Gastric Sling Fibers Analogy to Human Anatomy // Digestive Diseases, 1971, Vol.16 (6): 495-507.

The gastric sling fibers which take part in the sphincteric mechanism of the distal esophagus will contract if antral pH is low and relax when pH becomes higher. This phenomenon may explain the commonknown growth of the NERD after Hp eradication therapy because of the decrease of the antrum gastritis and gastrin production as well following by increasing of the stomach lumen pH. Taking in mind that the most popular medicine for the NERD to treat are the PPIs, it is not astonishing that treatment of this suffering is failed not so infrequently.

As for similarity between IBS and NERD, one will be able to answer this question when the IBS pathogenesis become clearer. I am sure that the neurosis of the bowel is the least cause of a given patient pain syndrome that a physian should seek for. The peptic ulcer disease was believed to be a kind of neurosis too not so long time ago...

In my experience the NERD is most frequently associated with IBS-C. Since I am primarily a clinician, I go back to my old past experience, when it was still in use cisapride,a potent prokinetic now withdrawn from the market due to serious cardiac side effects. Patients with both diseases (NERD and IBS-C) had often benefit for both disorders during therapy with cisapride.

So I think that both conditions (NERD and IBS) are part of a similar entity disease, related to dysmotility.

The new prokinetic drugs in pre-clinical phase should be tested also in this light.

Article Overlap of Erosive and Non-erosive Reflux Diseases With Func...

I think that NERD is not irritable bowel syndrome (IBS) of the esophagus. Because, there is a reflux in NERD. So, NERD is a organic disorder on the contraty of IBS which is a functional disorder.

Because IBD-C and NERD are both belonged to FGID and they have the similar etiologies.particularly stress plays a critical role in the pathogenesis.Antidepression drugs and anti-axiety drugs were often used to relief the symptom As adjuvantive drugs.However,we need many evidences collected to demonstrate the hypothesis before conclusion.

Good question Juliet. We know there's considerable overlap between IBS, dyspepsia and GORD/reflux, but a "common denominator" has not been found, to my knowledge. Individual (mucosal) resilience and sensitivity must play a role in NERD. Our Unit does a lot of pH monitoring & we see a subset of patients who have quite grossly elevated acid exposure times (with normal endoscopies) yet they don't report their symptoms as being extreme. Conversely, others (also with normal endoscopies) have very little reflux revealed on monitoring, yet describe their oesophageal discomfort as almost unbearable. The fairly broad application of impedance-pH monitors is adding to our understanding.

This "common denominator" is depression, considered as a neuro-biochemical disease, leading to multiple dysfunctions, sensitive and motor as well.

Psychic features are a frequent consequence, but, by no means the cause.

It is the explaination of various dysfunctions, digestive, but also of numerous other functions, like micturition, sleep, fatigue, pain, taste, sweating etc.

Open your eyes and you shall see!

The question is, why does this very depression, whatever it to be and were it 'denominator' in reality, cause the NERD namely, not the pancreatitis, sweating, or chronic anal fissure?

Actually, this question is as old as the nervism itself, and I do not wait for an answer. There must be a concrete proposal of the NERD pathogenesis, and such a hypothesis is worth to consider that can explain how the whole matter works :))

It is unclear whether the absence of tissue damage is referred to endoscopic findings or enclose also histology. Zentilin et al reported that histology was abnormal in 96% of patients with erosive esophagitis and in 76% of patients with nonerosive reflux disease (NERD) (Am j Gastroenterol, 2005). So it is possible that the real "functional" patients with NERD could be less numerous than believed.

All, has any progress been made on this discussion?

I am interested as a patient of 20 years and as a scientist (from a different field).