REVIEW: CLINICAL AND SYSTEMATIC REVIEWSDiagnosis and Management of Functional HeartburnHachem, Christine MD1; Shaheen, Nicholas J MD, MPH2Author Information 1Division of Gastroenterology, St Louis University, St Louis, Missouri, USA 2Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Correspondence: Christine Hachem, MD, Division of Gastroenterology, St Louis University, 3635 Vista Avenue, Firmin Desloge Tower, St Louis, Missouri 63110, USA. E-mail: [email protected] Received 09 June 2015; accepted 14 October 2015 Guarantor of the article: Christine Hachem, MD. Specific author contributions: Analysis and interpretation of evidence, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: Christine Hachem and Nicholas J. Shaheen. Financial support: Shaheen receives research funding from Covidien, CSA Medical, NeoGenomics, GI Dynamics, Takeda Pharmaceuticals, and CDx Diagnostics. Potential competing interests: None. American Journal of Gastroenterology: January 2016 - Volume 111 - Issue 1 - p 53-61 doi: 10.1038/ajg.2015.376 Buy Metrics Abstract Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists. Heartburn that does not respond to traditional acid suppression is a diagnostic and therapeutic dilemma. In the era of high utilization of proton pump inhibitors, a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease. Subjects without objective evidence of reflux as a cause of their symptoms have “functional heartburn”. The diagnostic role of endoscopy, reflux and motility testing in functional heartburn (FH) patients is discussed. Lifestyle modifications, pharmacological interventions, and alternative therapies for FH are also presented. Recognition of patients with FH allows earlier assignment of these patients to different treatment algorithms, which may allow greater likelihood of success of treatment, diminished resource utilization and improved quality of life. Further data on this large and understudied group of patients is necessary to allow improvement in treatment algorithms and a more evidence-based approach to care of these patients. © The American College of Gastroenterology 2016. All Rights Reserved.