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.