Gastroesophageal reflux disease (GERD) occurs when acid flows back from the stomach into the esophagus. Managing symptoms with the help of a doctor may prevent complications such as esophagitis.

About 20% of the population of the United States has GERD, and it is one of the most common digestive disorders in the US.

There are multiple types of GERD in which esophagitis — inflammation of the esophagus — may or may not be present. Healthcare professionals may refer to GERD without esophagitis as non-erosive reflux disease (NERD).

This article discusses GERD without esophagitis, explaining how it differs from other kinds of GERD, including its causes, symptoms, and treatments. It also explores when to contact a doctor and answers some common questions about GERD without esophagitis.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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GERD is a condition that develops when acid or other contents of the stomach frequently flow back into the esophagus, which is the tube that transports food from the mouth to the stomach.

Sometimes, when a person has GERD, their esophagus becomes inflamed and irritated. This can damage the cells lining the esophagus. Doctors may refer to this as reflux esophagitis or severe erosive esophagitis.

If a person has GERD accompanied by inflammation and damage to the esophagus, doctors may refer to it as GERD with esophagitis. However, if there are no signs of damage to the esophagus, then someone has GERD without esophagitis. Doctors may also call this NERD.

NERD is the most prevalent type of GERD, affecting 60–70% of people with the condition.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, GERD may have the following symptoms:

Less typical symptoms of GERD include chest pain, dental erosions, and asthma. People should discuss any symptoms with their doctor, who can determine the cause and provide a diagnosis.

GERD is primarily a disorder of the lower esophageal sphincter (LES), which is located where the esophagus meets the stomach. It helps protect the esophagus from the acidic contents of the stomach. Certain factors can cause the LES to malfunction, which may lead to GERD. These include:

  • hiatal hernia
  • anatomical reasons such as a shortened esophagus or ligament weakness
  • increased pressure in the abdomen

Experts also advise that asthma flare-ups may relax the LES, causing GERD symptoms. The American College of Gastroenterology (ACG) suggests that certain foods and lifestyle habits may weaken the LES, including:

There is no gold standard test for diagnosing GERD. Instead, doctors may diagnose GERD based on someone’s symptoms or assess their responsiveness to GERD medication.

However, the ACG advises that a gastroenterologist or other doctor may wish to carry out further tests to diagnose GERD without esophagitis. Testing procedures may include an endoscopy or an X-ray.

Doctors may recommend the following treatments and lifestyle strategies to manage GERD without esophagitis:

  • raising the head 6–10 inches off the bed using a foam wedge
  • avoiding lying down for at least 2 hours after eating and not eating for at least 2 hours before going to bed
  • avoiding tight clothing
  • losing weight if a person currently has overweight or obesity
  • changing the diet and eating habits with a doctor’s guidance
  • avoiding smoking and drinking alcohol

Doctors may also prescribe medications to treat GERD, such as H2 receptor antagonists and proton pump inhibitors (PPIs).

ACG guidelines suggest that PPIs may not be as effective in people with GERD without esophagitis, but this may be because some of the study populations had functional heartburn instead of GERD.

However, the guidelines reference a 1999 study, which found that 83% of people with NERD who took omeprazole experienced remission of symptoms after 6 months compared to 56% of those who took a placebo.

A person should speak with a healthcare professional if they think they have GERD. A doctor can identify the underlying cause of symptoms and monitor a person’s health if necessary. Doctors aim to help people manage GERD to prevent complications such as esophagitis and Barrett’s esophagus.

The ACG advises that if someone uses over-the-counter products for heartburn two or more times per week, they should consult a doctor who can advise them about other treatments.

Below are some common questions and answers about GERD and esophagitis.

What is the difference between esophagitis and GERD?

GERD occurs when acid flows back from the stomach into the esophagus. Esophagitis is inflammation or irritation of the esophagus, which may result from GERD.

Why do some people have GERD without esophagitis and others do not?

Esophagitis is a complication of GERD, so if someone does not manage their condition with the help of a doctor, they may have a higher risk of developing esophagitis. However, other factors may also increase a person’s risk of developing esophagitis. For example, males are more likely to develop it.

What are the types of GERD?

Experts classify GERD into three types:

  • NERD
  • erosive esophagitis
  • Barrett’s esophagus

What can be mistaken for GERD?

The following conditions may cause similar symptoms to GERD:

GERD without esophagitis is a type of GERD that does not involve inflammation of the esophagus. Doctors may also refer to this condition as NERD.

Esophagitis may develop as a complication of GERD, so people with symptoms of GERD should consult a doctor. A doctor can recommend treatments and lifestyle strategies to help people manage symptoms and prevent more severe conditions from developing.