Review article: the role of non‐acid reflux in gastro‐oesophageal reflux disease

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Abstract
The role of acid in the pathogenesis of gastro‐oesophageal reflux disease (GERD) has been extensively studied and is well accepted. The role, if any, of non‐acid reflux, in particular duodenogastro‐oesophageal reflux, is much debated. The availability of new technology to detect non‐acid reflux has heightened interest in this question. This article reviews the following: How do we define non‐acid reflux? Does duodenogastro‐oesophageal reflux (alone or in combination) cause oesophageal injury, symptoms or both? What is its role in complicated GERD? What methods are available to assess non‐acid reflux? Does non‐acid reflux need treatment and if so what modalities are available?