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Functional Heartburn: Definition and Management Strategies

  • Esophagus (MF Vela, Section Editor)
  • Published:
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Abstract

Functional heartburn (FH) is a functional gastro-intestinal disorder characterized by symptoms of heartburn not related to gastro-esophageal reflux. The absence of evidence of reflux-related symptoms relies on absence of esophagitis at endoscopy (including biopsies to exclude eosinophilic esophagitis), a normal esophageal acid exposure during esophageal pH-monitoring together with a negative symptom-reflux association analysis and an unsatisfactory response to proton pump inhibitor therapy. Addition of impedance measurement to pH-monitoring is likely to increase the number of patients with recognized reflux-related symptoms. The pathophysiology of functional heartburn remains largely unknown but involves disturbed esophageal perception and psychological factors such as depression, anxiety and somatization. The treatment of FH remains largely empirical and an individual approach is therefore recommended. The clinician should provide reassurance and refrain from performing too many invasive tests or therapeutic procedures. The use of pain modulators is recommended by most experts despite the lack of appropriate clinical trials to support it.

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Disclosure

Dr. S. Bruley des Varannes has been a board member for Janssen Cilag, IPRAD Laboratories, Cephalon Laboratories, Mayoli Spindler Laboratories, a consultant for Given Imaging, Novartis, and Danone, and has received payment for lectures from Astra Zeneca, Takeda, and Nycomed; Dr. J. P. Galmiche has been a board member and consultant for Astra Zeneca, and a consultant for Norgine and Xenoport. He has received payment for development of educational presentations from Shire Movetis, travel and accommodation reimbursement from Given Imaging, and support from Mauna Kea Technology; Dr. F. Zerbib has been a board member for Shire Movetis and a consultant for Given Imaging, Shire Movetis, Norgine, Xenoport, and Addex Pharma. He has received payment for lectures from Janssen Cilag, Abbott France, and AstraZeneca, and payment for development of educational presentations from Cephalon, Pfizer, and Nycomed; Dr. M. Simon reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Gastroenterology and Hepatology Department, Saint André Hospital, Centre Hospitalier Universitaire de Bordeaux; Université Bordeaux Segalen, Bordeaux, France

    Frank Zerbib & Mireille Simon

  2. Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France

    Stanislas Bruley des Varannes & Jean Paul Galmiche

  3. Gastroenterology Department, Saint Andre Hospital, 1, rue Jean Burguet, 33075, Bordeaux, France

    Frank Zerbib

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  1. Frank Zerbib
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  2. Stanislas Bruley des Varannes
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  3. Mireille Simon
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  4. Jean Paul Galmiche
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Correspondence to Frank Zerbib.

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Zerbib, F., Bruley des Varannes, S., Simon, M. et al. Functional Heartburn: Definition and Management Strategies. Curr Gastroenterol Rep 14, 181–188 (2012). https://doi.org/10.1007/s11894-012-0255-7

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