Most individuals with symptoms compatible with gastroesophageal reflux disease (GERD) who undergo endoscopy will not show evidence of erosive esopha-gitis. Indeed, it is now clear that non-erosive or nega-tive-endoscopy reflux disease (NERD) [also referred to as endoscopy-negative reflux disease (ENRD)], may account for up to 70% of patients with GERD in the community —. This contrasts with the spectrum of patients seen in a gastroenterological practice or tertiary referral center, where esophagitis and complicated GERD may predominate. However, until recently, most studies of diagnostic or therapeutic interventions in GERD were performed in the latter setting and may well, therefore, not be representative of the true spectrum of GERD. It is appropriate, therefore, to review our understanding of the clinical features, natural history, pathophysiology, evaluation and management of GERD, recognizing that the majority of patients have NERD and not erosive reflux disease (ERD) or one of its complications.
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