A perspective on the clinical relevance of weak or nonacid reflux

Background: Advances in ambulatory esophageal reflux monitoring that incorporated impedance electrodes to pH catheters have resulted in better characterization of retrograde bolus flow in the esophagus. With pH-impedance monitoring, in addition to acid reflux episodes identified by pH drops below 4.0, weakly acid reflux (WAR, pH 4-7) and nonacid reflux (NAR, pH >7.0) are also recognized, although both may be included under the umbrella term NAR. However, despite identification of ambulatory pH-impedance monitoring, data on clinical relevance and prognostic value of NAR are limited. The Lyon Consensus, an international expert review that defines conclusive metrics for gastroesophageal reflux disease (GERD), identifies NAR as supportive but not conclusive for GERD.Purpose: This review provides perspectives on whether NAR fulfills three criteria for clinical relevance: whether NAR sufficiently explains pathogenesis of symptoms, whether it is associated with meaningful manifestations of GERD, and whether it can predict treatment efficacy.

Automated summary

This review examines the clinical relevance and prognostic value of nonacid reflux (NAR) in esophageal reflux monitoring. The study finds that while NAR is associated with gastroesophageal reflux disease (GERD), its ability to explain symptom pathogenesis, meaningful manifestations of GERD, and predict treatment efficacy is limited.