REVIEW

Functional heartburn: the stimulus, the pain, and the brain

R Fass¹, G Tougas²

¹ Department of Medicine, Section of Gastroenterology, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona, USA
² Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Correspondence to:
Dr R Fass, Southern Arizona VA Health Care System, Section of Gastroenterology, 1-111G-1, Tucson, AZ 85723, USA;
Ronnie.Fass{at}med.VA.gov

Functional heartburn is a common disorder and appears to be composed of several distinct subgroups. Identifying the different subgroups based on clinical history only is not achievable at present. The mechanisms responsible for pain, clinical characteristics, and the optimal therapeutic approach remain poorly understood. Response to potent antireflux treatment is relatively limited. Current and future treatment strategies for functional heartburn patients who have failed standard dose proton pump inhibitors (PPIs) include increased PPI dose in some, as well as addition of pain modulators in others.

Keywords: gastro-oesophageal reflux disease; functional heartburn; non-erosive reflux disease; proton pump inhibitors

Abbreviations: GORD, gastro-oesophageal reflux disease; NERD, non-erosive reflux disease; PPI, proton pump inhibitor; TLOSR, transient lower oesophageal sphincter relaxation; PET, positron emission tomography; FMRI, functional magnetic resonance imaging

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Ian Forgacs
Gut 2002 51: 759. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Lee, Y-C, Yen, A M-F, Tai, J J, Chang, S-H, Lin, J-T, Chiu, H-M, Wang, H-P, Wu, M-S, Chen, T H-H (2009). The effect of metabolic risk factors on the natural course of gastro-oesophageal reflux disease. Gut 58: 174-181 [Abstract] [Full Text]  
• Vemulapalli, R. (2008). Diet and Lifestyle Modifications in the Management of Gastroesophageal Reflux Disease. Nutr Clin Pract 23: 293-298 [Abstract] [Full Text]  
• Emerenziani, S, Sifrim, D, Habib, F I, Ribolsi, M, Guarino, M P L, Rizzi, M, Caviglia, R, Petitti, T, Cicala, M (2008). Presence of gas in the refluxate enhances reflux perception in non-erosive patients with physiological acid exposure of the oesophagus. Gut 57: 443-447 [Abstract] [Full Text]  
• Matthews, P. J., Knowles, C. H., Chua, Y. C., Delaney, C., Hobson, A. R., Aziz, Q. (2008). Effects of the concentration and frequency of acid infusion on the development and maintenance of esophageal hyperalgesia in a human volunteer model. Am. J. Physiol. Gastrointest. Liver Physiol. 294: G914-G917 [Abstract] [Full Text]  
• Lawal, A., Kern, M., Sanjeevi, A., Antonik, S., Mepani, R., Rittmann, T., Hussaini, S., Hofmann, C., Tatro, L., Jesmanowicz, A., Verber, M., Shaker, R. (2008). Neurocognitive processing of esophageal central sensitization in the insula and cingulate gyrus. Am. J. Physiol. Gastrointest. Liver Physiol. 294: G787-G794 [Abstract] [Full Text]  
• Farre, R., De Vos, R., Geboes, K., Verbecke, K., Berghe, P. V., Depoortere, I., Blondeau, K., Tack, J., Sifrim, D. (2007). Critical role of stress in increased oesophageal mucosa permeability and dilated intercellular spaces. Gut 56: 1191-1197 [Abstract] [Full Text]  
• Soderholm, J. D (2007). Stress-related changes in oesophageal permeability: filling the gaps of GORD?. Gut 56: 1177-1180 [Abstract] [Full Text]  
• Drewes, A M, Reddy, H, Pedersen, J, Funch-Jensen, P, Gregersen, H, Arendt-Nielsen, L (2006). Multimodal pain stimulations in patients with grade B oesophagitis. Gut 55: 926-932 [Abstract] [Full Text]  
• Bredenoord, A J, Weusten, B L A M, Curvers, W L, Timmer, R, Smout, A J P M (2006). Determinants of perception of heartburn and regurgitation. Gut 55: 313-318 [Abstract] [Full Text]  
• Calabrese, C, Cenacchi, G, Trere, D, Fabbri, A, Derenzini, M, Miglioli, M, Di Febo, G (2005). Erosions or not in GORD? The potential role of oesophageal cell proliferation. Gut 54: 887-888 [Full Text]