Functional heartburn and non-erosive reflux disease

Area of Science:

• Gastroenterology
• Digestive Health
• Esophageal Disorders

Background:

• Gastroesophageal reflux disease (GERD) is prevalent, with endoscopy-negative reflux disease (NERD) representing up to 70% of cases.
• NERD patients are a diverse group with varied heartburn mechanisms, including reflux, hypersensitivity, and psychological factors.
• Traditional focus on erosive esophagitis has shifted towards understanding NERD presentations.

Purpose of the Study:

• To differentiate patient subgroups within NERD based on esophageal acid exposure and symptom correlation.
• To clarify the diagnostic criteria and appropriate treatment strategies for different NERD phenotypes, including functional heartburn.
• To evaluate the efficacy of proton pump inhibitor (PPI) therapy in distinct NERD classifications.

Main Methods:

• Classification of NERD patients based on esophageal pH testing (abnormal vs. normal acid exposure).
• Correlation analysis between reported symptoms (heartburn) and documented reflux events.
• Assessment of patient response to proton pump inhibitor (PPI) therapy.

Main Results:

• NERD patients with normal pH testing and a positive symptom-reflux correlation respond well to PPIs and are considered within GERD.
• A distinct group, functional heartburn, shows no abnormal pH findings or symptom correlation and exhibits a poor response to PPIs.
• Functional heartburn is increasingly recognized as distinct from GERD, suggesting alternative treatment approaches.

Conclusions:

• NERD is a heterogeneous condition requiring precise subclassification for effective management.
• Patients with functional heartburn, lacking objective reflux evidence, should not be treated with PPIs.
• Accurate diagnosis of NERD subtypes is crucial for optimizing GERD patient care and treatment selection.