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Functional heartburn: clinical characteristics and outcome

Surdea Blaga, Teodoraa,b,c; Dumitrascu, Danc; Galmiche, Jean-Paula,b; Bruley des Varannes, Stanislasa,b

European Journal of Gastroenterology & Hepatology: March 2013 - Volume 25 - Issue 3 - p 282–290
doi: 10.1097/MEG.0b013e32835b108f
Original Articles: Gastro-oesophageal Disorders

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.

aCIC-04 Inserm, Institut des Maladies de l'Appareil Digestif, CHU Nantes, France

bUniversité de Nantes, Faculté de Médecine, Nantes, France

cUniversity of Cluj, Cluj, Romania

Correspondence to Stanislas Bruley des Varannes, MD, PhD, Institut des Maladies de l’Appareil Digestif, CHU Nantes, 1, place Alexis Ricordeau, 44093 Nantes, France Tel: +33 2 40 08 33 06; fax: +33 2 40 08 75 06; e-mail:

Received August 1, 2012

Accepted October 4, 2012

© 2013 Lippincott Williams & Wilkins, Inc.