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18 | James Hubbard's My Family Doctor | The Magazine That Makes Housecalls cavity through the abdomen). • have a normal to low body-mass index. • have tested positive for the bacte- ria Helicobacter pylori. (H. pylori in your stomach, which can cause ulcers, usually decrease acid secre- tion.) It was easy to spot a nerd in high school; you looked for the pocket pro- tector, thick glasses or slide rule. Di- agnosing NERD in medical practice has not reached primetime. Gastroenterologists might sus- pect NERD if you fail to respond completely to strong acid-suppression medications. Testing will show that your lower esophageal sphincter works fine, and you don't have a lot of extra acid making it up your esophagus. So we can make a good guess at what you have. The bad news is, we can't successfully treat it—not yet, anyway. Acid-suppressing medication doesn't work well for NERDs. Meds to make your esophagus contract more effectively don't help; it's mov- ing just fine, thank you. Surgery to help your lower esophageal sphincter work better isn't as helpful in NERD as it is with some other GERD types. (That's controversial, though, because some believe the surgery, called Nis- Researchers have discovered that plain old gastroesophageal reflux disease has many subcategories. NERD is the most common. The others are: • ERD (erosive reflux disease): causes erosions (shallow ulcers) in the esophagus. Acid-reflux medication helps. • Barrett's esophagus: potentially precancerous condition in which the acid-attacked lower esophagus transforms itself into small-intestinal- lining cells to escape the damage (since these cells secrete mucous and bicarbonate). It has no symptoms, so if you're over 40 and have had GERD for a few years, ask your health-care provider if you should be checked. • eosinophilic esophagitis: allergic reaction of the esophagus to swal- lowed materials; it feels very much like standard reflux with a bit of dif- ficulty swallowing, and is treated by swallowing (not inhaling) the spray from mild steroid inhalers intended for asthma. • functional heartburn: With this one, there's no correlation between heartburn symptoms and anything regurgitating up the esophagus. People with functional heartburn do regurgitate, just not much, and it doesn't coincide with the pain. It's confusing for them and difficult to treat. We believe it's of a similar mechanism to irritable bowel syndrome, in which a slight irritation to the colon that wouldn't bother other people causes big pain. Proud to be a NERD May 25 is nerd pride day, also called Geek pride day. it originated in spain in 2006, according to Geekprideday. org. May 25, by the way, was when the first star Wars movie opened in 1977. san fundoplication, is useful in all kinds of GERD.) Nevertheless, don't despair. With up to 12 percent of the population having NERD, the pharmaceutical industry will no doubt be working hard at this condition. PatRicia RayMond, M.d., is a board-cer- tified gastroenterologist with Simply Screening in Chesapeake, Va.; author of Colonoscopy: It'll Crack U Up!; and assistant professor of clinical internal medicine at Eastern Vir- ginia Medical School. She's also a member of our editorial board.