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

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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

TLDR
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.

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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.

TLDR
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.

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

TLDR
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.

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TLDR
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.

The importance of functional diagnostics in determining the cause of antisecretary therapy inefficiency in a patient with heartburn: clinical observation

TLDR
The data of 24-hours pH-impedance demonstrated the absence of pathological reflux and the association of active symptoms with refluxes, which determined the functional nature of heartburn and explained the ineffectiveness of treatment with proton pump inhibitors.

References

SHOWING 1-10 OF 70 REFERENCES

Modern diagnosis of GERD: the Lyon Consensus

TLDR
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

TLDR
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
  • 2011

Management of Gastroesophageal Reflux Disease.

TLDR
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

TLDR
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?

TLDR
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

TLDR
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

TLDR
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.

TLDR
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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