Gastroesophageal reflux disease (GERD) happens when acidic stomach contents flow back up into the esophagus. This is known as acid reflux.

GERD is a common digestive disorder. It affects 20% of the population in the United States.

Generally, it’s thought to be related to problems with the lower esophageal sphincter (LES). The LES is the ring-shaped muscle at the bottom of the esophagus. If it doesn’t close properly, acid reflux can occur.

In some people, this can lead to esophagitis, or inflammation of the esophagus. Esophagitis is one of the main symptoms of GERD.

However, it’s possible to have GERD without esophagitis. Read on to learn about why this might happen, as well as how it’s diagnosed and treated.

Although GERD can lead to esophagitis, the conditions are separate disorders. This means you can have one condition without the other.

Both GERD and esophagitis affect the esophagus. Additionally, both conditions share symptoms such as:

However, there are some differences between GERD and esophagitis.

GERD is characterized by acid reflux. Esophagitis is characterized by inflammation, which is commonly caused by acid reflux and GERD. But there are many other possible causes of esophagitis.

These include:

  • radiation
  • infection
  • injury caused by medications
  • ingestion of acidic liquids
  • allergic reaction in the esophagus (eosinophilic esophagitis)

It’s possible to have GERD without esophagitis. This often affects people with refractory GERD.

Refractory GERD happens when GERD symptoms persist despite proton pump inhibitor (PPI) therapy. PPIs are medications that suppress acid but not the reflux itself.

Specifically, GERD is considered refractory when the symptoms happen three times a week after 8 weeks of PPI therapy.

Refractory GERD is less likely to cause esophagitis because the reflux is less acidic than untreated GERD. This is known as weakly acid reflux.

Weakly acid reflux is common in people who take PPIs, according to a 2021 review article. In this case, the esophagus is exposed to less acid, and inflammation fails to occur.

In fact, people with refractory GERD typically have typical endoscopy results. Endoscopies are used to examine the esophagus.

Esophagitis is one possible symptom of GERD. The condition can also cause the following symptoms:

See a doctor or healthcare professional if you experience:

If a doctor thinks you have GERD without esophagitis, they’ll ask questions about your symptoms and current medication. They’ll also do a physical examination.

The doctor will also likely use the following tests:

  • Upper endoscopy: In an upper endoscopy, a flexible tube with a camera is inserted into your esophagus. If you have GERD without esophagitis, your esophagus will look typical and healthy.
  • Ambulatory 24-hour pH probe: A small tube with a pH sensor is inserted into your esophagus. The sensor can identify the presence and acidity of reflux, which will indicate if you have esophagitis.

If you have refractory GERD, your upper endoscopy results will likely be typical. Thus, the ambulatory 24-hour pH probe is especially useful for diagnosing the condition.

If you’re already taking PPIs for GERD, you might need to keep taking them. This will continue suppressing the acidity of reflux episodes.

It’s also a good idea to continue lifestyle behaviors that help manage GERD.

You may need additional treatment to suppress the reflux itself. Options include:

Other medications

Other types of medication are more effective in controlling regurgitation and reflux. Examples include:

You may need to take these drugs in combination with PPIs.

Transoral incisionless fundoplication (TIF)

TIF is a nonsurgical procedure that reduces reflux of stomach contents. It’s ideal for GERD that involves regurgitation but no esophagitis.

In TIF, a device is inserted into the stomach through your mouth. The device folds the fundus, or top of the stomach, which prevents reflux.

Laparoscopic Nissen fundoplication

A Nissen fundoplication is the gold standard of surgical GERD treatments. In this surgery, the top of the stomach is wrapped around the esophagus, which improves the function of the LES.

Gastric bypass surgery

Gastric bypass surgery is often used for people who have obesity and GERD. It removes most of your stomach and some of your small intestine. This lowers acid production in the stomach, which decreases the amount of reflux as well.

Magnetic sphincter augmentation

Magnetic sphincter augmentation uses a device called the LINX. During the procedure, a beaded magnetic device is placed around the LES. This lowers LES pressure and prevents stomach contents from moving back up.

It’s possible to have GERD without esophagitis, or inflammation of the esophagus. This is often related to PPI therapy, which lowers the acidity of reflux. However, because PPIs don’t control the reflux itself, symptoms such as regurgitation may persist.

In this case, you’ll need treatment to control the reflux. This might include additional medication such as GABA agonists or prokinetic agents. Procedures such as TIF, laparoscopic Nissen fundoplication, gastric bypass surgery, and magnetic sphincter augmentation may also help.