AGA Clinical Practice Update on Functional Heartburn: Expert Review.

@article{Fass2020AGACP,
  title={AGA Clinical Practice Update on Functional Heartburn: Expert Review.},
  author={Ronnie Fass and Frank Zerbib and Chandra Prakash Gyawali},
  journal={Gastroenterology},
  year={2020}
}
Best Practice Advice 1 A diagnosis of functional heartburn should be considered when retrosternal burning pain or discomfort persists despite maximal (double-dose) proton pump inhibitor (PPI) therapy taken appropriately before meals during a 3-month period. Best Practice Advice 2 A diagnosis of functional heartburn requires upper endoscopy with esophageal biopsies to rule out anatomic and mucosal abnormalities, esophageal high-resolution manometry to rule out major motor disorders, and pH… 

Optimal management of severe symptomatic gastroesophageal reflux disease

In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti‐reflux surgery is a consideration.

Recent insights on functional heartburn and reflux hypersensitivity

The better ability to interpret impedance-pH tracings together with earlier data on the different prevalence of microscopic esophagitis in RH and FH patients, and recent studies documenting poor therapeutic efficacy of pain modulators and good results of antireflux surgery for RH support recategorization of RH within the GERD world.

Gastroesophageal reflux disease: risk factors, current possibilities of diagnosis and treatment optimisation

Daily impedance–pH monitoring is known to be an integral part of the diagnostic algorithm for GERD and is a functional diagnostic method to record all types of refluxes entering the oesophagus regardless of pH, to assess their association with symptoms, and to determine whether patients with heartburn symptoms belong to a particular phenotype.

Review article - esophageal reflux hypersensitivity: Non-GERD or still GERD?

  • V. SavarinoE. Marabotto E. Savarino
  • Medicine
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
  • 2020

Editorial: time to retire Rome IV and the Montreal definition? Authors' reply

In this study, it is found that severity of patientreported reflux symptoms, oesophageal hypervigilance and anxiety scale (EHAS) level, anxiety, and depression were similar across GERD phenotypes, implying that oesphagealhyperv Vigilance and visceral anxiety are important reflux symptom drivers across different GERDphenotypes.

VALUE OF PH-IMPEDANCE MONITORING PERFORMED 'ON' BID PROTON PUMP INHIBITOR THERAPY TO IDENTIFY NEED FOR ESCALATION OF REFLUX MANAGEMENT.

Combinations of abnormal pH-impedance metrics are associated with PPI non-response in proven GERD patients, and can be targeted for treatment escalation including surgery, particularly in regurgitation predominant GERD.

Reduced masticatory function predicts gastroesophageal reflux disease and esophageal dysphagia in patients referred for upper endoscopy: A cross-sectional study.

Overlap of functional heartburn and reflux hypersensitivity with proven gastroesophageal reflux disease

This data indicates that conventional FH/RH diagnosed off antisecretory therapy with overlap Fh/RH coexisting with proven GERD could overlap with proven gastroesophageal reflux disease.

Esophageal chemical clearance and mucosa integrity values in refractory gastroesophageal reflux disease patients with different esophageal dynamics.

PSPWI and MNBI, indicating impairment of esophageal chemical clearance and mucosa integrity, were lower in RGERD patients with multiple esphageal dynamic injuries than single injuries or normal dynamics and provided useful contributing information for potential dynamic injuries if manometry has already been found normal or marginal.

Gastroesophageal Reflux Disease: A General Overview

The pathophysiology of GERD is multifactorial, and a step-wise approach will assist physicians in making the diagnosis as GERD has a significant financial burden to the U.S. healthcare system.

References

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Modern diagnosis of GERD: the Lyon Consensus

Future GERD management strategies should focus on defining individual patient phenotypes based on the level of refluxate exposure, mechanism of refux, efficacy of clearance, underlying anatomy of the oesophagogastric junction and psychometrics defining symptomatic presentations.

ACG Practice Guidelines: Esophageal Reflux Testing

Guidelines for esophageal reflux testing are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees.

The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease.

  • E. SavarinoE. Marabotto V. Savarino
  • Medicine
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
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Management of Gastroesophageal Reflux Disease.

Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter.

Reflux Hypersensitivity: A New Functional Esophageal Disorder

Reflux hypersensitivity is very common and together with functional heartburn accounts for more than 90% of the heartburn patients who failed treatment with proton pump inhibitor twice daily and is primarily treated with esophageal neuromodulators, such as tricyclic anti-depressants and selective serotonin reuptake inhibitors.

Esophageal pH-Impedance Monitoring in Patients With Therapy-Resistant Reflux Symptoms: ‘On’ or ‘Off’ Proton Pump Inhibitor?

In order to demonstrate or exclude GERD in patients with PPI-resistant symptoms, ambulatory 24-h pH-impedance monitoring should preferably be performed after cessation of PPI therapy because this approach seems to offer the best chance to assess a relationship between symptoms and reflux episodes.

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period, which has a positive impact on patients’ management.

Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders

Imipramine for Treatment of Esophageal Hypersensitivity and Functional Heartburn: A Randomized Placebo-Controlled Trial

Although low-dose imipramine shows potential QoL benefits, it does not relieve symptoms more effectively than does placebo in patients with either esophageal hypersensitivity or functional heartburn.

Functional Esophageal Disorders.

Treatments directed at improving borderline motor dysfunction or reducing reflux burden to sub-normal levels have limited success in symptom improvement, and strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful.
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