Review

Functional heartburn: An underrecognized cause of PPI-refractory symptoms

Scott Gabbard, MD and Sonya Vijayvargiya,
Cleveland Clinic Journal of Medicine December 2019, 86 (12) 799-806; DOI: https://doi.org/10.3949/ccjm.86a.19006

ABSTRACT

Functional heartburn—persistent symptoms of esophageal reflux with no objective evidence of gastroesophageal reflux disease (GERD)—is the most common cause of failure of proton pump inhibitor (PPI) therapy, but it is often overlooked by internists and gastroenterologists.

View Full Text

REFERENCES

  1. ↵
    1. Vakil N,
    2. van Zanten SV,
    3. Kahrilas P,
    4. Dent J,
    5. Jones R; Global Consensus Group
    . The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101(8):1900–1920. doi:10.1111/j.1572-0241.2006.00630.x
    OpenUrlCrossRefPubMed
  2. ↵
    1. Dean BB,
    2. Gano AD Jr.,
    3. Knight K,
    4. Ofman JJ,
    5. Fass R
    . Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol 2004; 2(8):656–664. pmid:15290657
    OpenUrlCrossRefPubMed
  3. ↵
    1. Hachem C,
    2. Shaheen NJ
    . Diagnosis and management of functional heartburn. Am J Gastroenterol 2016; 111(1):53–61. doi:10.1038/ajg.2015.376
    OpenUrlCrossRef
  4. ↵
    1. Fass R,
    2. Sifrim D
    . Management of heartburn not responding to proton pump inhibitors. Gut 2009; 58(2):295–309. doi:10.1136/gut.2007.145581
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Aziz Q,
    2. Fass R,
    3. Gyawali CP,
    4. Miwa H,
    5. Pandolfino JE,
    6. Zerbib F
    . Functional esophageal disorders. Gastroenterology 2016; 150(6):1368–1379. doi:10.1053/j.gastro.2016.02.012
    OpenUrlCrossRef
  6. ↵
    1. Kondo T,
    2. Miwa H
    . The role of esophageal hypersensitivity in functional heartburn. J Clin Gastroenterol 2017; 51(7):571–578. doi:10.1097/MCG.0000000000000885
    OpenUrlCrossRef
  7. ↵
    1. Farmer AD,
    2. Ruffle JK,
    3. Aziz Q
    . The role of esophageal hypersensitivity in functional esophageal disorders. J Clin Gastroenterol 2017; 51(2):91–99. doi:10.1097/MCG.0000000000000757
    OpenUrlCrossRef
  8. ↵
    1. Mainie I,
    2. Tutuian R,
    3. Shay S, et al
    . Acid and nonacid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006;55(10):1398–1402. doi:10.1136/gut.2005.087668
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Katz PO,
    2. Gerson LB,
    3. Vela MF
    . Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108(3):308–328. doi:10.1038/ajg.2012.444
    OpenUrlCrossRefPubMed
  10. ↵
    1. Kahrilas PJ,
    2. Bredenoord AJ,
    3. Fox M, et al; International High Resolution Manometry Working Group
    . The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27(2):160–174. doi:10.1111/nmo.12477
    OpenUrlCrossRefPubMed
  11. ↵
    1. Kichler AJ,
    2. Gabbard S
    . A man with progressive dysphagia. Cleve Clin J Med 2017; 84(6):443–449. doi:10.3949/ccjm.84a.16055
    OpenUrlFREE Full Text
  12. ↵
    1. Roman S,
    2. Gyawali CP,
    3. Savarino E, et al; GERD consensus group
    . Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil 2017;29(10):1–15. doi:10.1111/nmo.13067
    OpenUrlCrossRefPubMed
  13. ↵
    1. Shaheen NJ,
    2. Falk GW,
    3. Iyer PG,
    4. Gerson LB; American College of Gastroenterology
    . ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111(1):30–50. doi:10.1038/ajg.2015.322
    OpenUrlCrossRefPubMed
  14. ↵
    1. Halder SL,
    2. Locke GR 3rd.,
    3. Schleck CD,
    4. Zinsmeister AR,
    5. Melton LJ 3rd.,
    6. Talley NJ
    . Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology 2007; 133(3):799–807. doi:10.1053/j.gastro.2007.06.010
    OpenUrlCrossRefPubMed
  15. ↵
    1. Park EY,
    2. Choi MG,
    3. Baeg M, et al
    . The value of early wireless esophageal pH monitoring in diagnosing functional heartburn in refractory gastroesophageal reflux disease. Dig Dis Sci 2013;58(10):2933–2939. doi:10.1007/s10620-013-2728-4
    OpenUrlCrossRefPubMed
  16. ↵
    1. Khajanchee YS,
    2. Hong D,
    3. Hansen PD,
    4. Swanström LL
    . Outcomes of antire-flux surgery in patients with normal preoperative 24-hour pH test results. Am J Surg 2004; 187(5):599–603. doi:10.1016/j.amjsurg.2004.01.010
    OpenUrlCrossRefPubMed
  17. ↵
    1. Viazis N,
    2. Keyoglou A,
    3. Kanellopoulos AK, et al
    . Selective serotonin reup-take inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study. Am J Gastroenterol 2012;107(11):1662–1667. doi:10.1038/ajg.2011.179
    OpenUrlCrossRefPubMed
  18. ↵
    1. Limsrivilai J,
    2. Charatcharoenwitthaya P,
    3. Pausawasdi N,
    4. Leelakusolvong S
    . Imipramine for treatment of esophageal hypersensitivity and functional heartburn: a randomized placebo-controlled trial. Am J Gastroenterol 2016;111(2):217–224. doi:10.1038/ajg.2015.413
    OpenUrlCrossRefPubMed
  19. ↵
    1. Keefer L,
    2. Kahrilas PJ
    . Low-dose tricyclics for esophageal hypersensitivity: is it all placebo effect? Am J Gastroenterol 2016; 111(2):225–227. doi:10.1038/ajg.2016.13
    OpenUrlCrossRef
  20. ↵
    1. Basu PP,
    2. Hempole H,
    3. Krishnaswamy N,
    4. Shah NJ,
    5. Aloysius M
    . The effect of melatonin in functional heartburn: a randomized, placebo-controlled clinical trial. Open J Gastroenterol 2014; 4(2):56–61. doi:10.4236/ojgas.2014.42010
    OpenUrlCrossRef
  21. ↵
    1. Watanabe S,
    2. Hattori T,
    3. Kanazawa M,
    4. Kano M,
    5. Fukudo S
    . Role of histaminergic neurons in hypnotic modulation of brain processing of visceral perception. Neurogastroenterol Motil 2007; 19(10):831–838. doi:10.1111/j.1365-2982.2007.00959.x
    OpenUrlCrossRefPubMed
  22. ↵
    1. Riehl ME,
    2. Kinsinger S,
    3. Kahrilas PJ,
    4. Pandolfino JE,
    5. Keefer L
    . Role of a health psychologist in the management of functional esophageal complaints. Dis Esophagus 2015; 28(5):428–436. doi:10.1111/dote.12219
    OpenUrlCrossRef
  23. ↵
    1. Klein KB,
    2. Spiegel D
    . Modulation of gastric acid secretion by hypnosis. Gastroenterology 1989; 96(6):1383–1387. pmid:2714570
    OpenUrlPubMed
  24. ↵
    1. Riehl ME,
    2. Pandolfino JE,
    3. Palsson OS,
    4. Keefer L
    . Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn. Dis Esophagus 2016; 29(5):490–496. doi:10.1111/dote.12353
    OpenUrlCrossRef

This article requires you to have a ccjm.org account to view the full text. If you already have an account, you may log in below to view this article along with all other CCJM content. If you do not have an account, register here. It’s free!

Back to top

Registration is Now Required for Free Access to CCJM Content

Register once and log in for full access to articles and content. Click “Register” in the upper right corner and follow the simple instructions to create a new account.

If you are using a mobile device, click on the settings icon to access the Register link.

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Subjects