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Functional heartburn patients demonstrate traits of functional bowel disorder but lack a uniform increase of chemoreceptor sensitivity to acid.
Am J Gastroenterol. 2006 May; 101(5):1084-91.AJ

Abstract

BACKGROUND

Functional heartburn (FH) patients have a profound impact on the response to anti-reflux therapy of the nonerosive reflux disease (NERD) group as compared to the response of the erosive esophagitis group. Thus far, there is paucity of information about their physiological and clinical characteristics that may separate them from the other NERD patients.

AIM

To compare physiological and clinical characteristics of patients with FH to their counterparts within the NERD group (NERD-positive [NERD+]).

METHODS

Subjects with typical heartburn symptoms, at least twice a week, were evaluated by an upper endoscopy. Only those with normal esophageal mucosa were recruited into the study and underwent pH testing to assess esophageal acid exposure. The patients were divided into those with normal pH test (FH) and those with abnormal pH test (NERD+). The groups were compared for demographics, gastroesophageal reflux disease symptom characteristics, psychological profile, and reported quality of life. Additionally, the two patient groups were compared for stimulus response functions to acid, autonomic function response, and rate of Helicobacter pylori infection.

RESULTS

Fifty-two patients included 30 with FH and the rest with NERD+. There was no statistical difference in demographics, frequency of hiatal hernia and H. pylori infection between the two groups. Patients with FH had a significantly longer history of heartburn and reported more episodes of chest pain than NERD+ patients (M--7.5 yr and M--once a week vs M--3.5 yr and M--once a month, respectively, p < 0.05). Patients with FH scored significantly higher in the somatization domain than patients with NERD+ (M--60 vs 52.5, p < 0.05), but had similar reported quality of life. Patients with NERD+ demonstrated a significantly shorter time to symptom perception and higher intensity rating (p < 0.05). Only patients with FH demonstrated a statistically significant increase in heart rate and skin conductance after acid perfusion, as compared to those with NERD+ (p < 0.05).

CONCLUSION

Patients with FH demonstrate increased reports of chest pain and somatization, an alteration in autonomic function but lack a uniform increase in chemoreceptor sensitivity to acid as compared to those with NERD+. This suggests that while FH patients harbor clinical traits of a functional bowel disorder, hypersensitivity to acid is not a general phenomenon.

Authors+Show Affiliations

The Neuro-Enteric Clinical Research Group, Department of Medicine, Section of Gastroenterology, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson 85723-0001, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16573776

Citation

Shapiro, Michael, et al. "Functional Heartburn Patients Demonstrate Traits of Functional Bowel Disorder but Lack a Uniform Increase of Chemoreceptor Sensitivity to Acid." The American Journal of Gastroenterology, vol. 101, no. 5, 2006, pp. 1084-91.
Shapiro M, Green C, Bautista JM, et al. Functional heartburn patients demonstrate traits of functional bowel disorder but lack a uniform increase of chemoreceptor sensitivity to acid. Am J Gastroenterol. 2006;101(5):1084-91.
Shapiro, M., Green, C., Bautista, J. M., Peru, R. L., Malagon, I. B., Corvo, M., Risner-Adler, S., Beeler, J. N., Tuchinsky, I., & Fass, R. (2006). Functional heartburn patients demonstrate traits of functional bowel disorder but lack a uniform increase of chemoreceptor sensitivity to acid. The American Journal of Gastroenterology, 101(5), 1084-91.
Shapiro M, et al. Functional Heartburn Patients Demonstrate Traits of Functional Bowel Disorder but Lack a Uniform Increase of Chemoreceptor Sensitivity to Acid. Am J Gastroenterol. 2006;101(5):1084-91. PubMed PMID: 16573776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional heartburn patients demonstrate traits of functional bowel disorder but lack a uniform increase of chemoreceptor sensitivity to acid. AU - Shapiro,Michael, AU - Green,Colleen, AU - Bautista,Jimmy M, AU - Peru,Raniero L, AU - Malagon,Isaac B, AU - Corvo,Matthew, AU - Risner-Adler,Sara, AU - Beeler,Joy N, AU - Tuchinsky,Irina, AU - Fass,Ronnie, PY - 2006/4/1/pubmed PY - 2006/6/7/medline PY - 2006/4/1/entrez SP - 1084 EP - 91 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 101 IS - 5 N2 - BACKGROUND: Functional heartburn (FH) patients have a profound impact on the response to anti-reflux therapy of the nonerosive reflux disease (NERD) group as compared to the response of the erosive esophagitis group. Thus far, there is paucity of information about their physiological and clinical characteristics that may separate them from the other NERD patients. AIM: To compare physiological and clinical characteristics of patients with FH to their counterparts within the NERD group (NERD-positive [NERD+]). METHODS: Subjects with typical heartburn symptoms, at least twice a week, were evaluated by an upper endoscopy. Only those with normal esophageal mucosa were recruited into the study and underwent pH testing to assess esophageal acid exposure. The patients were divided into those with normal pH test (FH) and those with abnormal pH test (NERD+). The groups were compared for demographics, gastroesophageal reflux disease symptom characteristics, psychological profile, and reported quality of life. Additionally, the two patient groups were compared for stimulus response functions to acid, autonomic function response, and rate of Helicobacter pylori infection. RESULTS: Fifty-two patients included 30 with FH and the rest with NERD+. There was no statistical difference in demographics, frequency of hiatal hernia and H. pylori infection between the two groups. Patients with FH had a significantly longer history of heartburn and reported more episodes of chest pain than NERD+ patients (M--7.5 yr and M--once a week vs M--3.5 yr and M--once a month, respectively, p < 0.05). Patients with FH scored significantly higher in the somatization domain than patients with NERD+ (M--60 vs 52.5, p < 0.05), but had similar reported quality of life. Patients with NERD+ demonstrated a significantly shorter time to symptom perception and higher intensity rating (p < 0.05). Only patients with FH demonstrated a statistically significant increase in heart rate and skin conductance after acid perfusion, as compared to those with NERD+ (p < 0.05). CONCLUSION: Patients with FH demonstrate increased reports of chest pain and somatization, an alteration in autonomic function but lack a uniform increase in chemoreceptor sensitivity to acid as compared to those with NERD+. This suggests that while FH patients harbor clinical traits of a functional bowel disorder, hypersensitivity to acid is not a general phenomenon. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16573776/Functional_heartburn_patients_demonstrate_traits_of_functional_bowel_disorder_but_lack_a_uniform_increase_of_chemoreceptor_sensitivity_to_acid_ L2 - http://Insights.ovid.com/pubmed?pmid=16573776 DB - PRIME DP - Unbound Medicine ER -