Established and Emerging Treatment Options for Functional Heartburn and Chest Pain

Functional heartburn and functional chest pain of presumed esophageal origin are characterized by symptoms suggesting an esophageal origin, but negative work-up on routine investigations, including ruling out gastroesophageal reflux disease. Visceral hypersensitivity is a potentially unifying pathophysiological concept, thought to underlie these disorders. In addition, there is important overlap with other functional disorders and psychiatric co-morbidity. This review summarizes current concepts on definition, diagnosis, and treatment options for functional heartburn and functional chest pain of presumed esophageal origin. Antidepressants are frequently used in these conditions, where they are presumed to act as neuromodulators of visceral hypersensitivity. There is a need for high-quality trials evaluating the efficacy of antidepressants and more specific neuromodulators, such as pregabalin, in functional esophageal disorders.