Issue link: http://cp.revolio.com/i/1520
May/Jun 2009 | www.MyFamilyDoctorMag.com | 17 Y ou come to my office with heartburn, I give you a pill you take once a day, and you get better. I am a goddess of gas- troenterology. Unless it doesn't work. For many of my patients, the sce- nario is more like: You come to my office already taking a powerful pill two, even three, times daily. You still have reflux, and the discomfort has a huge impact on your wellbeing. We endoscope you … and see absolutely nothing. What are you, nuts? Nah, you're likely a NERD. No, I haven't implied that you're a socially awkward, intelligent young person with glasses, braces and high- riding pants. I'm talking about a rela- tively new heartburn classification. You're likely already familiar with the term GERD, or good old gastroe- sophageal reflux disease. Well, now you need to meet someone new. nOTHInG TO SEE HERE! We now know GERD (a.k.a. heart- burn, indigestion, dyspepsia) is made up of various subcategories. Before we had uber-strong acid suppres- sors, we thought the main reflux was ERD, or erosive reflux disease. But we've found that 40 percent or less of people with reflux have that. Instead, most have NERD. NERD stands for non-erosive esophageal reflux disease. This means that when we gastroenterolo- gists scope you, there are no erosions or ulcers to see. Unfortunately for the NERDs, this lack of signs actu- ally makes it harder to treat. Much harder. THE BuRnInG COnunDRuM At the top of your stomach is a flap that keeps gastric juices down where they belong. It's called the lower esophageal sphincter. That little flap is the problem for some people with reflux: It's weakened and lets juices come up into the esophagus. Not so with NERD. The LES usually works fine for these folks. Further, NERDs have more re- flux episodes without acid. In fact, only 50 percent of NERDs have prolonged acid contact time. So there's pain with limited acid, which explains why all the anti-acid meds in the world won't completely stop the burning. Studies reveal that the esophagus in NERD patients is more sensitive to acid. Even weak acid can cause pain. Researchers have noticed that the spaces between the esophageal lining cells appear to be wider in these folks. They hypothesize that this may be responsible for the enhanced sensitiv- ity but they're not sure how. SIGnS OF A nERD According to a 2008 study in Diges- tion, if you have heartburn, the likeli- hood that it's NERD increases if you: • are of a younger age than people with ERD (no specific one stated, so just … younger). • are female. • don't have a hiatus hernia (when the stomach pokes up into the chest Attack of the NERD Hitch up your pants and install your pocket protector. if you have reflux, chances are it's not just GERD, it's nERD! by Patricia l. raymond, M.d., f.a.C.P., f.a.C.g.