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• Dyspepsia is distinguishable from heartburn
  Michael Camilleri
  Published on: 4 October 2005

• Published on: 4 October 2005

  Dyspepsia is distinguishable from heartburn

  • Michael Camilleri, physician

  Dear Editor,

  This systematic, original large study from the Leuven group proves what experienced physicians have appreciated for many years: that heartburn is a specific symptom that is easily identifiable by careful history or validated questionnaire, that heartburn is predictive of abnormal esophageal acid exposure in about 75% of people with the symptom, and that it occurs in a minority of patients with typical...

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  Dear Editor,

  This systematic, original large study from the Leuven group proves what experienced physicians have appreciated for many years: that heartburn is a specific symptom that is easily identifiable by careful history or validated questionnaire, that heartburn is predictive of abnormal esophageal acid exposure in about 75% of people with the symptom, and that it occurs in a minority of patients with typical or "true" dyspepsia especially when the latter represents symptoms other than pain or burning occurring after meal ingestion.

  The prevalence of <20% in the typical dyspepsia group of Tack et al is consistent with the high rate of somatic symptoms in these patients and it is likely that it represents "background noise". In a community based study of uninvestigated dyspepsia, the prevalence of heartburn was similar, and somatization scores (SCL-90) and somatic symptom checklist scores were higher than in community controls.[1]

  Data from this important study suggest that the subgroup of reflux-like dyspepsia (e.g. in Rome I criteria) should be discarded, that studies demonstrating efficacy of acid reduction in dyspepsia are generally uninformative in the context of true dyspepsia, and that inclusion criteria for true dyspepsia studies can be tightened by using a questionnaire to exclude heartburn rather than requiring laborious and costly 24 hour pH monitroing or upper gastrointestinal endoscopy.

  The implications of this study are very significant and they should be embraced by practising physicians, regulatory agencies and those who write consensus documents on symptom-based criteria for functional gastrointestinal disorders.

  Well done and best wishes.

  Sincerely,
  Michael

  References

  1. Castillo et al. 2004. Clinical Gastroenterology and Hrepatology 2:9850-996.

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  Conflict of Interest:
  None declared.

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