title: Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease.
abstract: OBJECTIVE
  The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients' outcome.
  
  
  METHODS
  Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38-57 years]) with a diagnosis of functional heartburn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index ≥ 50%). Outcome was assessed by review of hospital files and/or telephone interview.
  
  
  RESULTS
  Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients (P < 0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients (P < 0.05).
  
  
  CONCLUSIONS
  One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients' management.
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, Milan, Italy.
authors.forename: Roberto
authors.identifier: http://orcid.org/0000-0001-6918-9479
authors.initials: R
authors.lastname: Penagini
authors.affiliation: University College London Hospital, London, United Kingdom.
authors.forename: Rami
authors.initials: R
authors.lastname: Sweis
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, Milan, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Mauro
authors.affiliation: State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Gerson
authors.initials: G
authors.lastname: Domingues
authors.affiliation: Esophageal Lab, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Andres
authors.initials: A
authors.lastname: Vales
authors.affiliation: Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sifrim
keywords: Esophageal pH monitoring; Gastroesophageal reflux; Proton pump inhibitors
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