The difference between healing of erosive esophagitis and resolution of symptoms with PPI therapy now becomes more understandable. Patients presenting for upper endoscopy were stratified into reflux and nonreflux patients (control group) based on the presence and absence, respectively, of typical reflux symptoms. The significant anatomic and physiologic differences between the patient groups are shown in Fig. They were studied for 1 h under basal conditions and 1 h after taking 10 mL Faringel. Individuals are advised to consult with a healthcare professional before starting any diet, exercise, or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. The authors report only BE; visible CLE without intestinal metaplasia is not mentioned. The authors concluded that dilated intercellular spaces are a feature of reflux damage to squamous epithelium. When reflux-induced increased permeability is present, molecules of increasing size can enter the epithelium to an increasing depth as the size of the dilated intercellular spaces increases, which in turn is dependent on the amount of damage. The previous study was the first to introduce the concept that the progression of GERD while on PPI therapy was likely due to progressive LES damage during therapy. This should not be acceptable. Non‐erosive (NERD) and erosive (ERD) gastro‐oesophageal reflux disease (GORD) show similar severity of symptoms and impact on quality of life (QoL). As you read about nonerosive reflux disease, this subset of GERD might seem like a rare disorder. Classifications of Gastroesophageal Reflux Disease (GERD) and Response to Proton Pump Inhibitors (PPIs). Exclusion criteria were normal preoperative esophageal acid exposure on pH monitoring, esophageal pH monitoring performed elsewhere, previous antireflux surgery, and a named esophageal motility disorder or a low contraction amplitude in distal half of the esophagus. It doesn’t matter whether you have GERD or NERD…chronic acid reflux or mild symptoms. 66% of the patients had GERD for >5 years. First things first, there’s a difference between nonerosive reflux disease (NERD) and GERD. Two extremes can be visualized: Mild NERD results from relatively mild acid-induced damage that has resulted in a permeability increase that limits entry to small molecules (such as H+) into the superficial region of the epithelium, stimulating nociceptive receptors and producing heartburn. Their diagnostic value in reflux disease is limited; they certainly cannot be used to define reflux disease. The basal layer region is expanded from normal and now occupies more than 20% of the epithelial thickness. The most straightforward to calculate is the symptom index (SI). This is a patient whose heartburn responds quickly to low PPI doses. The intraepithelial nerve fibers bifurcate within the epithelium and have a beaded appearance because of dilatations. The technology is better than standard endoscopy, which fails to detect early changes in any of these patients. This concept was examined prospectively in a study of GERD patients with different degrees of LES and esophageal body functionality prior to therapy.16 A damaged LES was defined as a pressure less than 8 mm Hg and/or a LES abdominal length less than 1.2 cm.