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Update on Functional Heartburn.

Takahisa Yamasaki¹, Jessica O'Neil¹, Ronnie Fass¹

¹Dr Yamasaki is a research fellow at the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland, Ohio and a visiting scholar at Case Western Reserve University in Cleveland, Ohio. Ms O'Neil is a medical student at Case Western Reserve University. Dr Fass is the medical director of the Digestive Health Center, director of the Division of Gastroenterology and Hepatology, and head of the Esophageal and Swallowing Center at MetroHealth Medical Center, as well as a professor of medicine at Case Western Reserve University.

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|January 18, 2018

Summary

This summary is machine-generated.

Functional heartburn, defined by Rome IV criteria, involves typical heartburn symptoms without clear reflux causes. It often affects women and requires neuromodulator treatment when standard therapies fail.

Keywords:

Heartburn esophagus pH testing proton pump inhibitor upper endoscopy

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Area of Science:

Gastroenterology
Functional Gastrointestinal Disorders

Background:

Functional heartburn is characterized by typical heartburn symptoms despite normal upper endoscopy and esophageal pH testing, as per Rome IV criteria.
This condition is prevalent, particularly in women, and often co-occurs with reflux hypersensitivity, contributing significantly to refractory heartburn cases.
Functional gastrointestinal disorders, including functional heartburn, frequently present alongside psychological comorbidities.

Purpose of the Study:

To provide an updated definition and diagnostic approach for functional heartburn.
To highlight the prevalence and patient demographics affected by functional heartburn.
To outline current and potential treatment strategies for functional heartburn.

Main Methods:

Diagnosis involves upper endoscopy with biopsies, wireless pH capsule monitoring, pH-impedance monitoring, and high-resolution esophageal manometry.
Advanced endoscopic techniques like magnification endoscopy, chromoendoscopy, and narrow-band imaging may aid diagnosis.
Histopathological analysis and mucosal impedance measurements are valuable adjuncts for diagnosis.

Main Results:

Functional heartburn is defined by typical heartburn symptoms with a negative association to reflux events, normal endoscopy, and normal pH testing.
Reflux hypersensitivity is a key factor in patients with functional heartburn who do not respond to proton pump inhibitor therapy.
A significant overlap exists between functional heartburn and other functional gastrointestinal disorders, often with associated psychological conditions.

Conclusions:

Functional heartburn is a distinct clinical entity requiring specific diagnostic criteria and management.
Neuromodulators are the primary treatment for functional heartburn, with psychological interventions and complementary therapies playing supportive roles.
Accurate diagnosis relies on a combination of advanced testing to exclude other reflux-related pathologies.