Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn

Savarino, Edoardo; Zentilin, Patrizia; Mastracci, Luca; Dulbecco, Pietro; Marabotto, Elisa; Gemignani, Lorenzo; Bruzzone, Luca; Bortoli, Nicola de; Frigo, Anna Chiara; Fiocca, Roberto; Savarino, Vincenzo

doi:10.1007/s00535-012-0672-2

Cited by 163 publications

(154 citation statements)

References 30 publications

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“…However, they also showed that physicians often do not pay attention to a negative pH study continuing to prescribe PPIs and even sending their patients to antireflux surgery, as already observed in our previous study. 28 Furthermore our findings suggest that previous studies looking at morphological and/or pathophysiological differences between FH and NERD, diagnosed with 24-hour pH/pH-impedance studies, [10][11][12][13][14] may have been inaccurate. Structural characteristics, which are devoid of day to day fluctuations, ie, histopathological parameters or basal impedance, could be the best variables in order to diagnose FH, but their diagnostic performance needs to be evaluated against a gold standard.…”

Section: Discussionmentioning

confidence: 69%

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

Penagini

Sweis

Mauro

et al. 2015

J Neurogastroenterol Motil

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Background/Aims The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients’ outcome. Methods Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38–57 years]) with a diagnosis of functional heart-burn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index ≥ 50%). Outcome was assessed by review of hospital files and/or telephone interview. Results Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients ( P < 0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients ( P < 0.05). Conclusions One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients’ management.

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Section: Discussionmentioning

confidence: 69%

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

Penagini

Sweis

Mauro

et al. 2015

J Neurogastroenterol Motil

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“…It has been revealed that RH is more likely to present with esophageal mucosal changes than FH. 26 Furthermore, RH may respond less well than real NERD, so separating RH from real NERD and FH is of clinical significance. The current study also focused on the motility characteristics of heartburn patients.…”

Section: Discussionmentioning

confidence: 99%

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Zhang

Chen

Peng

et al. 2017

United European Gastroenterology Journal

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Background: The phenotypes of heartburn patients are heterogeneous. Objective: The objective of this study was to investigate the proportion of heartburn phenotypes in a Chinese population and to compare the Rome IV and III criteria for heartburn diagnosis. Methods: A retrospective study was performed among heartburn patients referred for upper endoscopy and esophageal function tests in a tertiary hospital. Their symptoms fulfilled Rome IV and III criteria. Results: A total of 233 patients were included. Fifty-nine patients (25%) were diagnosed with esophagitis, 96 (41%) with non-erosive reflux disease (NERD) and 78 (34%) with functional heartburn (FH) based on Rome III criteria. Approximately 70% of the Rome III NERD patients were changed based on Rome IV criteria, with 36 patients (15%) diagnosed with reflux hypersensitivity (RH) and 32 patients (14%) who didn't fulfill the criteria considered unclassified. The FH and RH patients showed higher esophagogastric junction-contractile integral (EGJ-CI) and less hiatal hernia than did Rome IV NERD patients. The unclassified had more hiatal hernias than the FH and RH (p < 0.05). The EGJ-CI was similar between Rome III NERD and FH cases. Conclusion: The Rome IV criteria were stricter for heartburn diagnosis and superior in distinguishing NERD from functional disorders on motility patterns than Rome III. KeywordsHeartburn, gastroesophageal reflux disease, function esophageal disorders, Rome III criteria, Rome IV criteria, screening and diagnosis non-erosive reflux disease (NERD) cases, among whom approximately 34% had functional heartburn (FH) and 15% had reflux hypersensitivity (RH). . The Rome IV criteria were superior to the Rome III criteria in distinguishing NERD from FH and RH according to motility characteristics. Approximately 14% of the patients didn't fit the updated criteria.

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“…This finding could be assumed as the consequence of the dilation of intercellular space diameters of the oesophageal mucosa in GERD patients, demonstrated in patients with or without pathological acid exposure time, and allows to confirm the diagnosis of GERD even when the other MII-pH variable are within the normal range. 25,26 In the present investigation, efforts were also focused to prospectively evaluate, in CC patients, the role of MII-pH variables in predicting PPI response. Responder CC patients were frequently characterised by pathological AET and/or lower IB values as well as by the concomitant presence of typical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Reflux pattern and role of impedance‐pH variables in predicting PPI response in patients with suspected GERD‐related chronic cough

Ribolsi

Savarino

Bortoli

et al. 2014

Aliment Pharmacol Ther

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Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn

Cited by 163 publications

References 30 publications

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Reflux pattern and role of impedance‐pH variables in predicting PPI response in patients with suspected GERD‐related chronic cough

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