Abstract
Nonerosive reflux disease (NERD) is the most common type of gastroesophageal reflux disease (GERD). Its clinical symptoms can recur, and clinical treatment is often ineffective, causing patients severe economic and psychological burden. In recent years, studies that have explored in-depth the pathogenesis of NERD have found that visceral hypersensitivity (VH) plays an important role. VH refers to the phenomenon that viscera react strongly to nociceptive stimuli or produce a negative reaction to physiological stimuli due to the decrease of one's visceral pain threshold. Studies have found that the VH mechanism in NERD primarily includes abnormal neurotransmitters, the activation of acid-sensitive receptors, and abnormal psychological factors—all of which we review in this article.
Highlights
gastroesophageal reflux disease (GERD), a common digestive system disease, has an incidence rate of 8.8%–25.9% in Europe, 18.1%–27.8% in North America, 23% in South America, and 8.7%–33.1% in the Middle East [1]
Scholars have gained a deeper understanding of the mechanism of visceral hypersensitivity (VH) in Nonerosive reflux disease (NERD)
Peripheral and central nervous system sensitization mediated by neuropeptides Substance P (SP) and calcitonin gene-related peptide (CGRP), the activation of acidsensitive receptors, abnormalities of mental and psychological factors, and the brain-gut axis may all be involved in the occurrence of VH in NERD (Figure 1)
Summary
GERD, a common digestive system disease, has an incidence rate of 8.8%–25.9% in Europe, 18.1%–27.8% in North America, 23% in South America, and 8.7%–33.1% in the Middle East [1]. NERD is without mucosal injury under endoscope and is called an “endoscopic negative gastroesophageal reflux disease,” of which acid reflux and heartburn are typical symptoms [6]. Compared to those with RE, some NERD patients have poor response to proton pump inhibitors (PPIs), and their clinical symptoms often recur repeatedly. For these patients, long-term medical treatment and repeated examination require a significant expenditure of social resources and severely affect patients’ quality of life [7].
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