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Diagnosis and Management of Functional Heartburn
Christine Hachem1, Nicholas J Shaheen2
1Division of Gastroenterology, St Louis University, St Louis, Missouri, USA.
Insights
Functional heartburn (FH) affects many patients unresponsive to acid suppression. Recognizing FH aids tailored treatments, improving outcomes and quality of life.
Area of Science:
- Gastroenterology
- Digestive Health
- Clinical Medicine
Background:
- Heartburn is a prevalent gastrointestinal symptom.
- A significant number of patients with chronic heartburn do not have reflux-mediated disease, posing a diagnostic challenge.
- Proton pump inhibitors are widely used, yet many patients remain symptomatic.
Purpose of the Study:
- To discuss the diagnostic and therapeutic approaches for functional heartburn (FH).
- To highlight the importance of identifying patients with FH for appropriate management.
- To review current data and suggest areas for future research in FH.
Main Methods:
- Review of diagnostic roles of endoscopy, reflux testing, and motility testing in FH.
- Discussion of lifestyle modifications, pharmacological interventions, and alternative therapies for FH.
- Analysis of the impact of recognizing FH on treatment algorithms and patient outcomes.
Main Results:
- Functional heartburn is diagnosed in patients without objective evidence of reflux.
- Various diagnostic tools are crucial for identifying FH.
- A range of treatments, including lifestyle changes and medications, are available for FH.
Conclusions:
- Identifying functional heartburn allows for earlier and more appropriate treatment strategies.
- Tailored management of FH can lead to improved treatment success, reduced healthcare costs, and enhanced quality of life.
- Further research is needed to refine treatment algorithms and establish evidence-based care for FH patients.
Abstract:
Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists. Heartburn that does not respond to traditional acid suppression is a diagnostic and therapeutic dilemma. In the era of high utilization of proton pump inhibitors, a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease. Subjects without objective evidence of reflux as a cause of their symptoms have "functional heartburn". The diagnostic role of endoscopy, reflux and motility testing in functional heartburn (FH) patients is discussed. Lifestyle modifications, pharmacological interventions, and alternative therapies for FH are also presented. Recognition of patients with FH allows earlier assignment of these patients to different treatment algorithms, which may allow greater likelihood of success of treatment, diminished resource utilization and improved quality of life. Further data on this large and understudied group of patients is necessary to allow improvement in treatment algorithms and a more evidence-based approach to care of these patients.
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