title: Functional Heartburn Overlaps With Irritable Bowel Syndrome More Often than GERD.
abstract: We aimed to evaluate the prevalence of irritable bowel syndrome (IBS) in patients with typical reflux symptoms as distinguished into gastroesophageal reflux disease (GERD), hypersensitive esophagus (HE), and functional heartburn (FH) by means of endoscopy and multichannel intraluminal impedance (MII)-pH monitoring. The secondary aim was to detect pathophysiological and clinical differences between different sub-groups of patients with heartburn.
  
  
  
  Patients underwent a structured interview based on questionnaires for GERD, IBS, anxiety, and depression. Off-therapy upper-gastrointestinal (GI) endoscopy and 24 h MII-pH monitoring were performed in all cases. In patients with IBS, fecal calprotectin was measured and colonoscopy was scheduled for values >100 mg/kg to exclude organic disease. Multivariate logistic regression analysis was performed to identify independent risk factors for FH.
  
  
  
  Of the 697 consecutive heartburn patients who entered the study, 454 (65%) had reflux-related heartburn (GERD+HE), whereas 243 (35%) had FH. IBS was found in 147/454 (33%) GERD/HE but in 187/243 (77%) FH patients (P<0.001). At multivariate analysis, IBS and anxiety were independent risk factors for FH in comparison with reflux-related heartburn (GERD+HE).
  
  
  
  IBS overlaps more frequently with FH than with GERD and HE, suggesting common pathways and treatment. HE showed intermediate characteristic between GERD and FH.
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Frazzoni
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Edoardo V
authors.initials: EV
authors.lastname: Savarino
authors.affiliation: Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy.
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Martinucci
authors.affiliation: Jagiellonian University, Cracow, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jania
authors.affiliation: Department of Surgery, Division of Surgery, Second University of Naples, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Department of Statistics, University of Bologna, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Scagliarini
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellini
authors.affiliation: Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Marabotto
authors.affiliation: Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy.
authors.forename: Manuele
authors.initials: M
authors.lastname: Furnari
authors.affiliation: Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Bodini
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Russo
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertani
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Natali
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.affiliation: Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Department of Internal Medicine, Division of Pharmacology and Chemotherapy, University of Pisa, Pisa, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Blandizzi
authors.affiliation: Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
authors.forename: Santino
authors.initials: S
authors.lastname: Marchi
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003113:Colonoscopy; D003863:Depression / Q000453:epidemiology*; D004935:Esophageal Diseases / Q000453:epidemiology / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005243:Feces / Q000737:chemistry; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology; D006356:Heartburn / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D039841:Leukocyte L1 Antigen Complex