Overlap of functional heartburn and reflux hypersensitivity with proven gastroesophageal reflux disease

Rengarajan, Arvind; Pomarat, Margaux; Zerbib, Frank; Gyawali, C. Prakash

doi:10.1111/nmo.14056

Cited by 18 publications

(19 citation statements)

References 22 publications

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“…Moreover, Yadlapati et al revealed that patients with NERD, RH and FH had similar levels of psychosocial symptom and hypervigilance scales 28 . Furthermore, Rengarajan et al demonstrated that patients with proven GERD with overlapping FH and RH undergoing ambulatory reflux monitoring on PPI therapy have identical levels of anxiety and depression compared to conventional FH and RH diagnosed off PPI therapy in unproven GERD 30 . In our cohort, levels of EHAS, both depression and anxiety are distributed similarly among GERD phenotypes.…”

Section: Discussionsupporting

confidence: 62%

“…In our cohort, levels of EHAS, both depression and anxiety are distributed similarly among GERD phenotypes. Since pathological GERD and functional disorders may overlap and coexist, 30‐32 these differences among different studies are potentially related to patients' selection with varying extents of overlapping that are difficult to confirm or demonstrate.…”

Section: Discussionmentioning

confidence: 99%

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Oesophageal hypervigilance and visceral anxiety relate to reflux symptom severity and psychological distress but not to acid reflux parameters

Wong

Liu

et al. 2021

Aliment Pharmacol Ther

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Summary Background The pathogenesis of gastro‐oesophageal reflux disease (GERD) is complex and multifactorial. The oesophageal hypervigilance and anxiety scale (EHAS) is a novel cognitive‐affective evaluation of visceral sensitivity. Aims To investigate the interrelationship between EHAS and reflux symptom severity, psychological stress, acid reflux burden, phenotypes, and oesophageal mucosal integrity in patients with GERD. Methods Patients with chronic reflux symptoms and negative endoscopy underwent 24‐hour impedance‐pH monitoring for phenotyping, acid reflux burden, and mucosal integrity with mean nocturnal baseline impedance (MNBI) calculation. Validated scores for patient‐reported outcomes, including EHAS, GERD questionnaire (GERDQ), State‐Trait Anxiety Inventory score, and Taiwanese Depression Questionnaire score, were recorded. Results We enrolled 105 patients, aged 21‐64 years (mean, 48.8), of whom 58.1% were female; 27 had non‐erosive reflux disease, 43 had reflux hypersensitivity and 35 had functional heartburn. There were no significant differences in sex, EHAS, GERDQ, questionnaires of depression or anxiety among GERD phenotypes. EHAS was significantly correlated with GERDQ, questionnaires of depression and anxiety (P < 0.05). However, there were no significant correlations between GERDQ and questionnaires of depression or anxiety. Regarding patient‐reported outcomes, GERDQ positively correlated with acid exposure time and negatively correlated with MNBI (P < 0.05). Conclusions EHAS associates with reflux symptom severity and psychological stress but not with acid reflux burden or mucosal integrity. Thus, EHAS assessment shows promise in assessment of subjective patient outcome and satisfaction with treatment, a hitherto unmet clinical need.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Oesophageal hypervigilance and visceral anxiety relate to reflux symptom severity and psychological distress but not to acid reflux parameters

Wong

Liu

et al. 2021

Aliment Pharmacol Ther

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“…98 Yet others have demonstrated similar psychological profiles between functional heartburn and reflux hypersensitivity. 172 These data suggest that reflux hypersensitivity might be a heterogeneous category, but more research is needed to clarify which patients with reflux hypersensitivity require GERD management vs. neuromodulators vs. both.…”

Section: Pathophys Iologymentioning

confidence: 98%

ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease

Zerbib

Bredenoord²,

Fass

et al. 2020

Neurogastroenterology Motil

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Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term "refractory GERD" has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD-related), refractory GERD symptoms (ie, persisting symptoms in patients with proven GERD, regardless of relationship to ongoing reflux), and refractory GERD (ie, objective evidence of GERD despite adequate medical management). The present ESNM/ANMS consensus paper proposes use the term "refractory GERD symptoms" only in patients with persisting symptoms and previously proven GERD by either endoscopy or esophageal pH monitoring. Even in this context, symptoms may or may not be reflux related. Objective evaluation, including endoscopy and esophageal physiologic testing, is requisite to provide insights into mechanisms of symptom generation and evidence of true refractory GERD. Some patients may have true ongoing refractory acid or weakly acidic reflux despite PPIs, while others have no evidence of ongoing reflux, and yet others have functional esophageal disorders (overlapping with proven GERD confirmed off therapy). In this context, attention should also be paid to supragastric belching and rumination syndrome, which may be important contributors to refractory symptoms.

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“…Broadly, this is a focus of the Rome Foundation Overlap in DGBI working team who will aim to provide guidance on further testing and management of DGBI symptoms in patients with organic disease, including how to prioritize different treatment strategies such as when centrally versus peripherally acting treatments should be used and the use of BGBT in the context of both clinical trials and practice 28 . In the realm of esophageal disorders, a study has shown that patients with diagnoses of functional heartburn or reflux hypersensitivity have similar clinical, psychological, and functional profiles compared with patients with proven GERD and overlap with functional heartburn or reflux hypersensitivity overlap 29 …”

Section: Future Directionsmentioning

confidence: 99%

The Clinical value of brain‐gut behavioral therapies for functional esophageal disorders and symptoms

Luo

Keefer

2022

Neurogastroenterology Motil

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Functional esophageal disorders, now included under the umbrella of disorders of gut-brain interaction (DGBI) according to Rome IV, present with esophageal symptoms not associated with a structural, major motility or underlying inflammatory condition. 1 In a recent global study on the burden of 2 functional gastrointestinal disorders, the global prevalence of any of the five functional esophageal disorder defined by Rome IV diagnostic criteria (functional chest pain, functional heartburn, reflux hypersensitivity, globus, and functional dysphagia) was about 6.0%. The most prevalent esophageal disorder was functional dysphagia; the rates for functional heartburn, reflux hypersensitivity, and esophageal chest pain were substantially lower. All esophageal disorders were more prevalent among women; however, there was a divergence in results in terms of age, with decreasing rates in the older age groups in the countries surveyed via

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Overlap of functional heartburn and reflux hypersensitivity with proven gastroesophageal reflux disease

Cited by 18 publications

References 22 publications

Oesophageal hypervigilance and visceral anxiety relate to reflux symptom severity and psychological distress but not to acid reflux parameters

Oesophageal hypervigilance and visceral anxiety relate to reflux symptom severity and psychological distress but not to acid reflux parameters

ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease

The Clinical value of brain‐gut behavioral therapies for functional esophageal disorders and symptoms

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