title: Functional heartburn:  clinical characteristics and outcome.
abstract: OBJECTIVE
  Patients with heartburn and normal upper gastrointestinal endoscopy, normal oesophageal acid exposure, no symptom-reflux association and who fail to respond to a proton-pump inhibitor are classified as having functional heartburn (FH). This study aimed (i) to characterize the symptoms and functional abnormalities of patients with FH and (ii) to describe their clinical outcome.
  
  
  METHODS
  Among all patients referred for 24 h multichannel intraluminal impedance-pH (MII-pH), patients with FH were identified. The clinical characteristics and high-resolution oesophageal pressure topography recordings of FH patients were analyzed at the time of the 24-h MII-pH test. A symptom-related and health-related quality-of-life questionnaire was then sent to FH patients to assess the long-term outcome.
  
  
  RESULTS
  Forty patients fulfilled the criteria for FH, representing 8.5% of the referred population. Twenty-two months after initial testing, 66% of patients still suffered from heartburn. The rate of mixed reflux (liquid/gas) was higher in patients with persisting heartburn at the final evaluation (63 vs. 50%, P=0.04). Sixty-six per cent of patients had one or more manometric abnormalities. Acid clearance time in MII-pH was significantly higher in patients with weak peristalsis than patients with normal peristalsis (60 ± 45 vs. 31 ± 19 s, P=0.03). A high rate of mixed reflux and/or a manometric abnormality were associated with a higher risk of persistent heartburn.
  
  
  CONCLUSIONS
  FH is a chronic disorder with persisting symptoms in two-thirds of patients. An increased rate of mixed reflux and/or the presence of manometric abnormalities are associated with a higher risk of persisting symptoms and may help to identify the population with unmet therapeutic needs.
authors.affiliation: CIC-04 Inserm, Institut des Maladies de l'Appareil Digestif, CHU Nantes, France.
authors.forename: Teodora
authors.initials: T
authors.lastname: Surdea Blaga
authors.forename: Dan
authors.initials: D
authors.lastname: Dumitrascu
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.forename: Stanislas
authors.initials: S
authors.lastname: Bruley des Varannes
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D006356:Heartburn / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D011237:Predictive Value of Tests; D011312:Pressure; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors