Treatments for Nonerosive Reflux Disease (NERD)

Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES) does not close properly, so stomach contents leak back, or reflux, into the esophagus.

For some patients, GERD can cause erosive esophagitis, a condition that causes inflammation, erosions, and ulcers to form in the esophagus. Erosive esophagitis can be seen with an endoscope—an instrument with a light and a camera on it that allows a healthcare provider to visualize a person's digestive system.

But many people have what is called nonerosive reflux disease, or NERD. With NERD, people experience typical GERD symptoms caused by acid reflux, but they do not have any visible esophageal injury.

Treatment for NERD is similar to that for erosive GERD. Depending on the severity of symptoms, treatment may involve one or more of the following: lifestyle changes, medications, or surgery.

Patient describing stomach pain to doctor.
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Lifestyle Changes

According to the American College of Gastroenterology, lifestyle habits are a component of managing acid reflux disease.

  • Weight loss: If you are overweight or obese (which means a body mass index of greater than 25), or if you have recently gained weight, weight loss is strongly recommended. The science behind this is that extra weight along your waistline can increase abdominal pressure, which can then push stomach contents up into the esophagus.
  • Elevating the head of your bed, especially if your symptoms of reflux are worse at night and/or wake you up at night, is suggested.
  • Stopping smoking and drinking alcohol may also be helpful, although this change has not been conclusively proven in scientific studies to help with GERD symptoms. Still, many healthcare providers will recommend it on an individual basis.
  • Eliminating certain foods can also be helpful for managing symptoms of acid reflux, especially chocolate, caffeine, spicy foods, citrus, and carbonated drinks. This change can be particularly useful for people who note a link between their symptoms and one or more specific foods. 
  • Eating small meals (as large meals may increase upward pressure against the esophageal sphincter) and avoiding eating meals at least two to three hours before going to bed or reclining may also be helpful.


Your healthcare provider may recommend over-the-counter antacids, which work by neutralizing the acid in the stomach, or medications that stop acid production.

  • Antacids, such as Maalox, Mylanta, Tums, and Rolaids are usually the first drugs recommended relieving heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. The downside is that antacids have some potential side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
  • H2 blockers, such as Tagamet, Pepcid, Axid, and Zantac, impede acid production. They are available in prescription strength and over-the-counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time without the proper guidance of a healthcare provider.
  • Proton pump inhibitors include Prilosec, Prevacid, Protonix, Aciphex, and Nexium, which are all available by prescription. Prilosec is available in an over-the-counter form (Prilosec OTC). Proton pump inhibitors (PPIs) are a group of medications that prevent the release of acid in the stomach and intestines. Proton pump inhibitors also should not be used for more than a few weeks at a time without guidance from a healthcare provider.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac. The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping medication. For more information, visit the FDA site.


Surgical options for people with GERD include laparoscopic fundoplication or bariatric surgery in a person who is obese. In a laparoscopic fundoplication, the upper region of the stomach is wrapped around the lower part of the esophagus. In addition, two new endoscopic techniques for treating GERD—suturing and the Stretta radio frequency technique—have been approved by the FDA. The decision to undergo surgery is a complicated one and requires thoughtful discussions between a person and his or her healthcare providers.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ha NR, Lee HL, Lee OY, et al. Differences in clinical characteristics between patients with non-erosive reflux disease and erosive esophagitis in Korea. J Korean Med Sci. 2010;25(9):1318-22. doi:10.3346/jkms.2010.25.9.1318

  2. Acid Reflux. American College of Gastroenterology.

  3. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-28. doi:10.1038/ajg.2012.444

Additional Reading

By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.