Journal
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
Volume 25, Issue 3, Pages 282-290Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEG.0b013e32835b108f
Keywords
functional heartburn; gastro-oesophageal reflux; oesophageal manometry; pH impedancemetry
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Funding
- Doctoral studies: through science towards society [posdru 6/1.5/s/3]
- AstraZeneca
- Mauna Kea Technologies
- Given Imaging and Janssen-Cilag
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Objectives Patients with heartburn and normal upper gastrointestinal endoscopy, normal oesophageal acid exposure, no symptom-reflux association and who fail to respond to a proton-pump inhibitor are classified as having functional heartburn (FH). This study aimed (i) to characterize the symptoms and functional abnormalities of patients with FH and (ii) to describe their clinical outcome. Materials and methods Among all patients referred for 24 h multichannel intraluminal impedance-pH (MII-pH), patients with FH were identified. The clinical characteristics and high-resolution oesophageal pressure topography recordings of FH patients were analyzed at the time of the 24-h MII-pH test. A symptom-related and health-related quality-of-life questionnaire was then sent to FH patients to assess the long-term outcome. Results Forty patients fulfilled the criteria for FH, representing 8.5% of the referred population. Twenty-two months after initial testing, 66% of patients still suffered from heartburn. The rate of mixed reflux (liquid/gas) was higher in patients with persisting heartburn at the final evaluation (63 vs. 50%, P = 0.04). Sixty-six per cent of patients had one or more manometric abnormalities. Acid clearance time in MII-pH was significantly higher in patients with weak peristalsis than patients with normal peristalsis (60 +/- 45 vs. 31 +/- 19 s, P = 0.03). A high rate of mixed reflux and/or a manometric abnormality were associated with a higher risk of persistent heartburn. Conclusion FH is a chronic disorder with persisting symptoms in two-thirds of patients. An increased rate of mixed reflux and/or the presence of manometric abnormalities are associated with a higher risk of persisting symptoms and may help to identify the population with unmet therapeutic needs. Eur J Gastroenterol Hepatol 25:282-290 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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