title: Esophageal acid sensitivity and mucosal integrity in patients with functional heartburn.
abstract: BACKGROUND
  Patients with functional heartburn (FH) experience troublesome heartburn that is not related to gastroesophageal reflux. The etiology of the heartburn sensation in FH patients is unknown. In patients with reflux disease, esophageal hypersensitivity seems associated with impaired mucosal integrity. We aimed to determine esophageal sensitivity and mucosal integrity in FH and non-erosive reflux disease (NERD) patients.
  
  
  METHODS
  In this prospective experimental study, we performed an acid perfusion test and upper endoscopy with biopsies in 12 patients with NERD and nine patients with FH. Mucosal integrity was measured during endoscopy using electrical tissue impedance spectroscopy and biopsy specimens were analyzed in Ussing chambers for transepithelial electrical resistance and transepithelial permeability.
  
  
  RESULTS
  Lag time to heartburn perception was significantly longer in FH patients (median 12 min) than in NERD patients (median 3 min). Once perceived, intensity of heartburn was scored equal with median visual analog scale 6.5 and 7.1 respectively. Esophageal mucosal integrity was also comparable between FH and NERD patients, both in vivo extracellular impedance and ex vivo transepithelial resistance and permeability were similar.
  
  
  CONCLUSIONS
  Patients with FH did not show acid hypersensitivity as seen in patients with NERD. However, once perceived, intensity of heartburn is similar. Esophageal mucosal integrity is similar between NERD and FH patients, and is therefore unlikely to be the underlying cause of the observed difference in esophageal acid perception.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: P W
authors.initials: PW
authors.lastname: Weijenborg
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A J P M
authors.initials: AJ
authors.lastname: Smout
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. a.j.bredenoord@amc.uva.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bredenoord
mesh_terms: D000328:Adult; D000071041:Esophageal Mucosa / Q000378:metabolism*; D050782:Esophageal pH Monitoring / Q000379:methods*; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006356:Heartburn / Q000175:diagnosis* / Q000378:metabolism* / Q000523:psychology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010465:Perception / Q000502:physiology; D011446:Prospective Studies
keywords: 
  NERD
  ; esophagus; functional heartburn; mucosal integrity; reflux