Radiofrequency ablation reduces esophageal hypersensitivity in refractory non-erosive reflux disease

Refractory non-erosive gastroesophageal reflux disease (rNERD) involves complex interactions between esophageal sensitivity receptors (PAR2/TRPV1) and persistent proton pump inhibitor (PPI)-refractory symptoms. This study exclusively employed radiofrequency ablation (RFA) as the uniform endoscopic intervention. All 20 enrolled rNERD patients underwent standardized RFA procedures; no participants underwent mucosal resection or ligation procedures. Post-intervention analysis demonstrated significant reductions in PAR2/TRPV1 expression (PAR2: 81.8% → 35.5%; TRPV1: 1.6 → 0.9 by Western blot) and inflammatory infiltration. Symptom improvement correlated with receptor downregulation (Reflux Symptom Index (RSI): 14.6 → 5.0; Gastroesophageal Reflux Disease Questionnaire (GERD-Q): 14.0 → 7.6). These findings indicate that endoscopic RFA alleviates rNERD symptoms through dual mechanisms: anatomical correction and esophageal hypersensitivity modulation via PAR2/TRPV1 pathways.