The American Foregut Society Consensus on Nonerosive Reflux Disease

Objective: This American Foregut Society consensus utilized existing literature and international expert opinion to provide a better definition and clinical approach to nonerosive reflux disease (NERD) that harmonizes with modern published concepts and consensus processes. Methods: A core expert group (14 gastroenterologists and foregut surgeons) developed the initial statements supported by a systematic literature review using a modified Delphi process. The statements were reviewed and voted upon by a separate voting group (17 expert gastroenterologists and foregut surgeons). Multiple iterations of the statements were created with anonymous voting and virtual discussions to develop consensus. Consensus agreement required ≥80% of voting group rating statements 7 to 9 on a 9-point Likert scale. Results: The core group proposed 41 statements, with the most in the treatment and prognosis category (n = 12) and the fewest in the definition category (n = 4). After round one, there was a consensus of agreement on 25 statements (61%). In round two, a virtual discussion was held, and the 16 remaining statements underwent language modification for repeat voting. In round three, consensus was reached on 11 of the 16 statements. Therefore, agreement was reached on 36 of the original 41 proposed statements (87.8%). The final statements with consensus agreement ranged from definition of NERD (n = 4), epidemiology and natural course (n = 8), pathophysiology (n = 6), diagnosis (n = 6), to treatment and prognosis (n = 12). Conclusions: Evidence-based statements provide a clinical description of NERD and a standardized framework for future collaborative research.

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Publication Details

Journal
Foregut The Journal of the American Foregut Society
Published
2026-11-01
DOI
https://doi.org/10.1177/26345161261493497
Primary Topic
Gastroesophageal reflux and treatments
Type
article
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article

The American Foregut Society Consensus on Nonerosive Reflux Disease

Luigi Bonavina, Reginald C. W. Bell, Felice H. Schnoll‐Sussman, Hiroto Miwa et al.
Foregut The Journal of the American Foregut Society
Gastroesophageal reflux and treatments
article

The American Foregut Society Consensus on Nonerosive Reflux Disease

Luigi Bonavina, Reginald C. W. Bell, Felice H. Schnoll‐Sussman, Hiroto Miwa, Ronnie Fass, Frank Zerbib, Rena H. Yadlapati, John C. Lipham, Albert Jan Bredenoord, Leena Khaitan, Walter W. Chan, José Tawil, Daniel Pohl, Rishi D. Naik, Thomas Watson, Gary W. Falk, Vani J. A. Konda, Marcelo F. Vela, Philip O. Katz, Chandra Prakash Gyawali, John Erik Pandolfino, Peter J. Kahrilas, Prashanthi Nagavenkata Thota, David A. Katzka, José María Remes-Troche, Oh Young Lee, John M. Clarke, Michael Fredrick Vaezi, Kristle Lynch, Afrin K. Rahman, Stuart Spechler
article en

Abstract

Objective: This American Foregut Society consensus utilized existing literature and international expert opinion to provide a better definition and clinical approach to nonerosive reflux disease (NERD) that harmonizes with modern published concepts and consensus processes. Methods: A core expert group (14 gastroenterologists and foregut surgeons) developed the initial statements supported by a systematic literature review using a modified Delphi process. The statements were reviewed and voted upon by a separate voting group (17 expert gastroenterologists and foregut surgeons). Multiple iterations of the statements were created with anonymous voting and virtual discussions to develop consensus. Consensus agreement required ≥80% of voting group rating statements 7 to 9 on a 9-point Likert scale. Results: The core group proposed 41 statements, with the most in the treatment and prognosis category (n = 12) and the fewest in the definition category (n = 4). After round one, there was a consensus of agreement on 25 statements (61%). In round two, a virtual discussion was held, and the 16 remaining statements underwent language modification for repeat voting. In round three, consensus was reached on 11 of the 16 statements. Therefore, agreement was reached on 36 of the original 41 proposed statements (87.8%). The final statements with consensus agreement ranged from definition of NERD (n = 4), epidemiology and natural course (n = 8), pathophysiology (n = 6), diagnosis (n = 6), to treatment and prognosis (n = 12). Conclusions: Evidence-based statements provide a clinical description of NERD and a standardized framework for future collaborative research.

Foregut The Journal of the American Foregut Society
Northwestern University (US), University of Southern California (US), Brigham and Women's Hospital (US), Cleveland Clinic (US), Harvard University (US), Université de Bordeaux (FR), Medical University of South Carolina (US), University of Zurich (CH), Washington University in St. Louis (US), University Hospitals of Cleveland (US), Baylor University Medical Center (US), Amsterdam UMC Location University of Amsterdam (NL), Centre Hospitalier Universitaire de Bordeaux (FR), University of California San Diego (US), Azienda Ospedaliera di Cosenza (IT), Gastroenterología Diagnóstica Terapeútica (AR), Mayo Clinic in Arizona (US), Corewell Health William Beaumont University Hospital (US), Stanford Medicine (US), Hanyang University Seoul Hospital (KR), Amsterdam University Medical Centers (NL), MetroHealth Medical Center (US), Weill Cornell Medicine (US), Kawanishi City Hospital (JP), University of Calabria (IT), Hanyang University (KR), Case Western Reserve University (US), University of Pennsylvania (US), Vanderbilt University Medical Center (US), Stanford University (US)
Openalex Percentile: Top 10%
Gastroesophageal reflux and treatments
DOISourceOpenAlex
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