Symptom association probability does not reliably distinguish functional heartburn from reflux hypersensitivity

2018 ◽  
Vol 47 (7) ◽  
pp. 958-965 ◽  
Author(s):  
Y. Choksi ◽  
J. C. Slaughter ◽  
R. Sharda ◽  
T. Higginbotham ◽  
P. Lal ◽  
...  
Keyword(s):  
Functional Heartburn ◽  
Symptom Association Probability

788 VARIABLE GEOGRAPHICAL DIFFERENCES OF AMBULATORY ESOPHAGEAL REFLUX MONITORING IN MEXICO

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Genaro Vazquez-Elizondo ◽  
José María Remes-Troche ◽  
Enrique Coss-Adame ◽  
Edgardo Suárez-Morán ◽  
Miguel Ángel Valdovinos-Díaz ◽  
...  
Keyword(s):  
Data Base ◽  
Positive Symptom ◽  
Central Mexico ◽  
Limited Information ◽  
Esophageal Reflux ◽  
Erosive Disease ◽  
Functional Heartburn ◽  
Symptom Association Probability ◽  
Common Diagnosis ◽  
Diagnostic Outcome

Abstract   Ambulatory esophageal reflux monitoring (AEpH) is useful in evaluating persistent or refractory esophageal symptoms despite adequate pharmacologic and/or surgical therapy. There is limited information whether there are geographical or regional differences in the diagnostic outcome of this test. Aim Characterize the diagnostic outcome of AEpH in a diverse population of Mexico. Analyze whether there is regional geographical diagnostic variability. Methods Data was collected from four major referral centers representing diverse geographical areas of Mexico: Mexico City-Central (two centers, years 2016-2020), Veracruz-South (years 2015-2020) and Monterrey-North (years 2013-2020). Consecutive patients undergoing AEpH with persistent GERD symptoms despite PPI therapy and negative upper endoscopy (no erosive disease >C or D LA classification) were entered into a data base and analyzed. Patients were classified as: NERD (acid exposure time (AET > 6.0%); hypersensitive esophagus (normal AET and positive symptom index (SI) or positive symptom association probability [SAP]); functional heartburn (NL AET, neg SI/SAP). Statistics: ANOVA, Chi-square and descriptive methods were used to compare variables among groups. Results 969 cases met inclusion criteria: 311 (32.1%) Central, 430 (44.3%) South, and 228 (23.5%) North. The results are summarized in the table. There were more women 618(63.8%) than men 351(36.2%); p < 0.001 with a mean age 47.7 ± 14.3. Patients were older in Central-Mexico 49.3 ± 13.6 years vs South 47.5 ± 15 and North 46.1 ± 13.6; p = 0.033. Functional heartburn was the most common diagnosis overall and more prevalent in Central-Mexico 171(55%) vs North 97(42.5%) and South 160(37.2%); p < 0.001. NERD was more predominant in the South 171(39.8%) vs North 72(31.6%) and Central-Mexico 98(31.5%); p = 0.029. Hypersensitive esophagus was more frequent in the North 59(25.9%) vs South 99(23%), and Central 42(13.5%); p < 0.001. Conclusion This is the first large data base study to evaluate the outcome of ambulatory esophageal reflux pH testing in Mexico. Our findings indicate a geographical variability of GERD phenotypes and suggest that further investigations are warranted to determine the causes of this distribution.

Usefulness of Endoscopic-Guided Measurement of Mucosal Admittance in Differentiating Gerd from Functional Heartburn

2017 ◽  
Vol 152 (5) ◽  
pp. S657
Author(s):  
Tomoaki Matsumura ◽  
Hideaki Ishigami ◽  
Mai Fujie ◽  
Kenichiro Okimoto ◽  
Daisuke Maruoka ◽  
...  
Keyword(s):  
Functional Heartburn

956 Impairment of Chemical Clearance and Mucosal Integrity Distinguish Hypersensitive Esophagus From Functional Heartburn

2016 ◽  
Vol 150 (4) ◽  
pp. S189-S190 ◽  
Author(s):  
Marzio Frazzoni ◽  
Nicola de Bortoli ◽  
Leonardo Frazzoni ◽  
Manuele Furnari ◽  
Irene Martinucci ◽  
...  
Keyword(s):  
Functional Heartburn ◽  
Mucosal Integrity

GABRA6 genetic polymorphism is associated with the risk of functional heartburn in Chinese

2007 ◽  
Vol 22 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Yi-Chia Lee ◽  
Hsiu-Po Wang ◽  
Han-Mo Chiu ◽  
Shih-Pei Huang ◽  
Shih-Cheng Liao ◽  
...  
Keyword(s):  
Genetic Polymorphism ◽  
Functional Heartburn

VISCERAL SENSITIVITY IN FUNCTIONAL HEARTBURN IS NOT ORGAN SPECIFIC

2003 ◽  
Vol 98 ◽  
pp. S10
Author(s):  
Sheila Rodriguez-Stanley ◽  
Sattar Zubaidi ◽  
Susan Riley ◽  
Philip B. Miner
Keyword(s):  
Visceral Sensitivity ◽  
Functional Heartburn ◽  
Organ Specific

scholarly journals Functional heartburn has more in common with functional dyspepsia than with non-erosive reflux disease

Gut ◽  
2009 ◽  
Vol 58 (9) ◽  
pp. 1185-1191 ◽  
Author(s):  
E Savarino ◽  
D Pohl ◽  
P Zentilin ◽  
P Dulbecco ◽  
G Sammito ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Reflux Disease ◽  
Functional Heartburn

scholarly journals Objective Evidence of Gastro-Esophageal Reflux Disease is Rare in Patients with Autoimmune Gastritis

2021 ◽  
Vol 30 (1) ◽  
pp. 30-36
Author(s):  
Valentina Pilotto ◽  
Gemma Maddalo ◽  
Costanza Orlando ◽  
Matteo Fassan ◽  
Massimo Rugge ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Serum Biomarkers ◽  
Functional Heartburn ◽  
High Resolution Manometry ◽  
Reflux Symptoms ◽  
Objective Evidence ◽  
Rome Iv

Background and Aims: Patients with autoimmune atrophic gastritis (AAG) often complain of acid reflux symptoms, despite the evidence of hypo-achlorhydria. Rome IV criteria are used to define functional esophageal disorders. Our aim was to characterize gastroesophageal reflux disease (GERD) phenotypes in patients with AAG. Methods: Between 2017-2018, 172 AAG patients were evaluated at Gastro-Oncology outpatient clinic of University of Padua. Of them, 38 patients with reflux symptoms underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH). Seventy-six AAG consecutive patients asymptomatic for gastroesophageal reflux were selected as age and gender matched controls. Serum biomarkers (pepsinogens, gastrin-17 and Helicobacter pylori antibodies), upper endoscopy, histology and clinical data were compared. Results: Out of 38/172 (22%) AAG patients with reflux symptoms, 2/38 had a GERD diagnosis based on abnormal esophageal acid exposure and 6/38 had a major motility disorder (i.e. outflow obstruction). Among the 30/38 patients with normal endoscopic findings, 9/30 had reflux hypersensitivity, 19 functional heartburn, 1 functional globus, 1 functional chest pain according to the Rome IV criteria. Antral atrophy, advanced corpus atrophy and OLGA stage were more frequent in controls than in reflux patients (p=0.01, p=0.031, p=0.01, respectively). No differences were found for serum biomarkers and symptom presentation. Most of the patients received proton pump inhibitors (PPIs) treatment (87%), with a minority (34%) reporting clinical benefit. Conclusions: Reflux symptoms are relatively common in AAG patients, but a firm diagnosis of GERD is rare (5%), whereas most of the patients have a functional disorder. PPI treatment is mostly clinical ineffective and should not be largely indicated.

scholarly journals El lado más sensible del esófago en relación con el reflujo gastroesofágico. Enseñanzas de ROMA IV

2020 ◽  
Vol 50 (1) ◽  
Author(s):  
José Tawil ◽  
Ronnie Fass
Keyword(s):  
Proton Pump Inhibitor ◽  
Diagnostic Category ◽  
Acid Reflux ◽  
Peripheral Sensitization ◽  
Functional Heartburn ◽  
Proton Pump Inhibitor Treatment ◽  
Esophageal Hypersensitivity ◽  
Inhibitor Treatment ◽  
Rome Iv ◽  
Normal Acid

Rome IV incorporated a new diagnostic category into the functional esophageal disorders group called reflux hypersensitivity. This new name replaced the term hypersensitive esophagus and included patients with normal acid reflux parameters but with symptomatic correlation with reflux events. Functional heartburn, which denoted lack of correlation between symptoms and reflux events in the background of normal pH test, and reflux hypersensitivity, should be excluded in heartburn patients who failed proton pump inhibitor treatment. Reflux hypersensitivity patients demonstrates esophageal hypersensitivity to reflux (any type), and both, reflux hypersensitivity and functional heartburn’s symptoms are driven by central and peripheral sensitization. The correct differentiation between these two esophageal disorders allows a therapeutic approach with greater chance of success. Neuromodulators are considered the mainstay of treatment for these patients even though patients with reflux hypersensitivity demonstrate response to anti-reflux treatment as well.

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