Gastroesophageal reflux disease (GERD) happens when acidic stomach contents flow back into the esophagus. Although GERD can lead to esophagitis, they’re two separate disorders. This means you can have one condition without the other.

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 signs 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.

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, commonly caused by acid reflux and GERD. However, there are many other possible causes of esophagitis.

These include:

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

It’s possible to have GERD without esophagitis. This could be because the acidity of the reflux is weakened, suppressed by medications, or simply doesn’t cause any damage to the esophagus.

People who experience reflux without acidity have non-esophageal reflux disease (NERD).

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

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

Your healthcare professional may perform 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, indicating if you have esophagitis.

If you’re already using proton pump inhibitor (PPI) therapy for GERD, you’ll likely continue this medication. PPIs 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 the reflux of stomach contents. It’s ideal for GERD with regurgitation but without 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.

Nissen fundoplication

Nissen fundoplication, also known as Nissen 360-degree wrap, 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.

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. Likewise, esophagitis can be caused by other things besides GERD.

Initial treatment typically involves PPIs. If you do not respond to PPIs or have additional risk factors, an endoscopy may be helpful to confirm or exclude a GERD diagnosis.

If your endoscopy is diagnostic of GERD, yet you do not respond to medications, further testing may be required. Additional medications, such as GABA agonists or prokinetics, or surgery may be needed.