Medical term for heartburn
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Medical Term for Heartburn: Understanding Functional Heartburn and GERD
Definition and Symptoms of Heartburn
Heartburn, also known as acid indigestion, is a burning sensation in the chest or throat caused by stomach acid refluxing into the esophagus. This symptom is often associated with gastroesophageal reflux disease (GERD) when it occurs frequently8. Heartburn can manifest as a burning, often hot sensation localized in the throat or substernal region, and is particularly common during pregnancy3.
Functional Heartburn: A Distinct Condition
Functional heartburn (FH) is a subtype of heartburn that is not related to gastroesophageal reflux. It is characterized by typical heartburn symptoms but with normal findings on upper endoscopy, normal esophageal pH testing, and a negative association between symptoms and reflux events2 6. Unlike GERD, FH does not respond well to proton pump inhibitor (PPI) therapy, indicating a different underlying mechanism2.
Pathophysiology of Functional Heartburn
The exact cause of functional heartburn remains largely unknown, but it is believed to involve disturbed esophageal perception and psychological factors such as depression, anxiety, and somatization2. Additionally, FH is often accompanied by other functional gastrointestinal disorders and psychological comorbidities6. Proposed mechanisms include esophageal visceral hypersensitivity, sustained esophageal contractions, and abnormal tissue resistance5.
Diagnosis and Management
Diagnosing functional heartburn involves a combination of endoscopy with esophageal biopsies, wireless pH capsule, pH-impedance monitoring, and high-resolution esophageal manometry6. Despite the lack of specific clinical trials, pain modulators are commonly recommended for treatment. Psychological interventions and complementary and alternative medicine may also play important roles in managing FH2 6.
Heartburn in Pregnancy
Heartburn is particularly prevalent during pregnancy, affecting about 50% of pregnant women, and typically resolves after delivery3. The self-limited nature of pregnancy makes it an ideal period to study heartburn, with esophageal motility studies being a useful diagnostic tool3.
Economic and Clinical Impact
Heartburn and dyspepsia have a significant economic impact due to their high prevalence. In Western nations, the annual prevalence of recurrent heartburn is approximately 15%4. Despite the substantial burden, the long-term natural history of these conditions remains inadequately described4.
Conclusion
Heartburn, whether as a symptom of GERD or as functional heartburn, presents a complex clinical challenge. Understanding the distinctions between these conditions is crucial for effective diagnosis and management. While GERD-related heartburn is typically acid-mediated and responsive to PPIs, functional heartburn requires a more nuanced approach involving pain modulators and psychological support. Further research is needed to fully elucidate the pathophysiology and optimal treatment strategies for functional heartburn.
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Most relevant research papers on this topic
Heartburn and similar gastric complaints
Restoring normal gastric acidity and drinking adequate water with meals can help prevent heartburn and other gastric complaints.
Functional Heartburn: Definition and Management Strategies
Functional heartburn is a functional gastro-intestinal disorder characterized by symptoms of heartburn not related to gastro-esophageal reflux, with a largely empirical treatment approach involving reassurance and pain modulators.
Heartburn in late pregnancy. Manometric studies of esophageal motor function.
Late pregnancy heartburn is common and disappears after delivery, making it an ideal experimental period for studying esophageal motility.
Non-RCT
Large Human Trial
Highly CitedDyspepsia and heartburn: a clinical challenge
Dyspepsia and heartburn have high prevalence in the population, but their long-term natural history remains inadequately described, with a significant economic impact.
The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis.
Abnormal tissue resistance is the main cause of heartburn in nonerosive reflux disease, reconciling various proposed mechanisms and reaffirming the definition of reflux-associated "heartburn" as an acid-mediated event requiring antacids.
Highly Cited