AGA Clinical Practice Update on Functional Heartburn: Expert Review

Area of Science:

• Gastroenterology
• Functional GI Disorders

Background:

• Functional heartburn presents as persistent retrosternal burning pain unresponsive to standard treatments.
• Accurate diagnosis is crucial to differentiate from gastroesophageal reflux disease (GERD) and other esophageal conditions.

Purpose of the Study:

• To provide best practice advice for diagnosing and managing functional heartburn.
• To clarify treatment strategies, including pharmacologic and non-pharmacologic options.

Main Methods:

• Diagnosis involves ruling out organic causes via endoscopy and manometry, and confirming abnormal acid exposure patterns.
• Utilizes Rome IV criteria for overlapping functional heartburn and GERD.
• Evaluates therapeutic efficacy of various treatments.

Main Results:

• Proton pump inhibitors (PPIs) are ineffective for functional heartburn unless overlapping with proven GERD.
• Neuromodulators (e.g., TCAs, SSRIs) and H2 receptor antagonists show therapeutic benefit.
• Acupuncture and hypnotherapy may serve as effective monotherapy or adjunctive treatments.

Conclusions:

• Functional heartburn diagnosis requires a systematic approach excluding other pathologies.
• Treatment should focus on neuromodulators and complementary therapies, avoiding anti-reflux surgery.