Assessment of relationship between acid reflux and heartburn using receiver operating characteristic curves.
Arguments proposed in this article may explain why a subgroup of patients, having so-called "functional heartburn," does not respond to acid inhibition therapy [19,20]. It is highly likely that acid is not the cause of heartburn in this group of subjects. These conclusions are supported further by observations of Wiener et al [2] and Howard et al [21], who found that a subgroup of patients with high SI have a negative Bernstein test, which suggests that the presence of acid in the esophagus at the time of spontaneous heartburn may be coincidental and does not reflect a cause-and-effect relationship between the two. The motor events responsible for the occurrence of acid reflux (longitudinal muscle contraction of the esophagus [SEC] associated with transient LES relaxation) may be the cause of heartburn sensation.
Steinbach
Joseph
J
University of California San Diego and San Diego Veterans Affairs Medical Center, San Diego, CA 92161, USA.
Fass
Ronnie
R
Mittal
Ravinder K
RK
D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006356:Heartburn / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008365:Manometry; D012372:ROC Curve; D012720:Severity of Illness Index