title: Functional chest pain responds to biofeedback treatment but functional heartburn does not:  what is the difference?
abstract: BACKGROUND
  Patients with functional esophageal disorders represent a challenging treatment group. The purpose of this study was to evaluate the role of biofeedback in the treatment of patients with functional esophageal disorders.
  
  
  METHODS
  In this prospective study, patients with typical/atypical symptoms of gastroesophageal reflux disease underwent upper endoscopy and 24-h pH monitoring. All patients filled out gastroesophageal Reflux Disease Symptom, Hospital Anxiety and Depression, and Symptom Stress Rating questionnaires. Patients with functional heartburn and those with functional chest pain were offered biofeedback treatment. A global assessment questionnaire was filled out at the end of treatment and then 2.8 (range 1-4) years later.
  
  
  RESULTS
  From January 2006 to December 2009, 22 patients with functional esophageal diseases were included in the study. Thirteen had functional heartburn and nine had functional chest pain. Six patients from each group received biofeedback treatment. After treatment for 1-4 years, patients with functional chest pain showed significant improvements in symptoms compared with those who were not treated. Patients with functional heartburn showed no improvement. Patients with functional chest pain had a longer time of esophageal acid exposure than those with functional heartburn.
  
  
  CONCLUSIONS
  Patients with functional chest pain have different central and intraesophageal factors associated with symptom generation in comparison with patients with functional heartburn. Biofeedback is a useful tool in the treatment of patients with functional chest pain, but not for those with functional heartburn.
authors.affiliation: Institute of Gastroenterology, Liver Diseases, Assaf Harofeh Medical Center, Zerifin, Israel. mshapiro@asaf.health.gov.il
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: Ram
authors.initials: R
authors.lastname: Shanani
authors.forename: Hanna
authors.initials: H
authors.lastname: Taback
authors.forename: Dov
authors.initials: D
authors.lastname: Abramowich
authors.forename: Eitan
authors.initials: E
authors.lastname: Scapa
authors.forename: Efrat
authors.initials: E
authors.lastname: Broide
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D002637:Chest Pain / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000378:metabolism; D006356:Heartburn / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult