PMID- 32017911
OWN - NLM
STAT- MEDLINE
DCOM- 20210217
LR  - 20210217
IS  - 1528-0012 (Electronic)
IS  - 0016-5085 (Linking)
VI  - 158
IP  - 8
DP  - 2020 Jun
TI  - AGA Clinical Practice Update on Functional Heartburn: Expert Review.
PG  - 2286-2293
LID - S0016-5085(20)30128-1 [pii]
LID - 10.1053/j.gastro.2020.01.034 [doi]
AB  - BEST PRACTICE ADVICE 1: A diagnosis of functional heartburn should be considered 
      when retrosternal burning pain or discomfort persists despite maximal 
      (double-dose) proton pump inhibitor (PPI) therapy taken appropriately before 
      meals during a 3-month period. BEST PRACTICE ADVICE 2: A diagnosis of functional 
      heartburn requires upper endoscopy with esophageal biopsies to rule out anatomic 
      and mucosal abnormalities, esophageal high-resolution manometry to rule out major 
      motor disorders, and pH monitoring off PPI therapy (or pH-impedance monitoring on 
      therapy in patients with proven gastroesophageal reflux disease [GERD]), to 
      document physiologic levels of esophageal acid exposure in the distal esophagus 
      with absence of reflux-symptom association (ie, negative symptom index and 
      symptom association probability). BEST PRACTICE ADVICE 3: Overlap of functional 
      heartburn with proven GERD is diagnosed according to Rome IV criteria when 
      heartburn persists despite maximal PPI therapy in patients with history of proven 
      GERD (ie, positive pH study, erosive esophagitis, Barrett's esophagus, or 
      esophageal ulcer), and pH impedance testing on PPI therapy demonstrates 
      physiologic acid exposure without reflux-symptom association (ie, negative 
      symptom index and symptom association probability). BEST PRACTICE ADVICE 4: PPIs 
      have no therapeutic value in functional heartburn, the exception being proven 
      GERD that overlaps with functional heartburn. BEST PRACTICE ADVICE 5: 
      Neuromodulators, including tricyclic antidepressants, selective serotonin 
      reuptake inhibitors, tegaserod, and histamine-2 receptor antagonists have benefit 
      as either primary therapy in functional heartburn or as add-on therapy in 
      functional heartburn that overlaps with proven GERD. BEST PRACTICE ADVICE 6: 
      Based on available evidence, acupuncture and hypnotherapy may have benefit as 
      monotherapy in functional heartburn, or as adjunctive therapy combined with other 
      therapeutic modalities. BEST PRACTICE ADVICE 7: Based on available evidence, 
      anti-reflux surgery and endoscopic GERD treatment modalities have no therapeutic 
      benefit in functional heartburn and should not be recommended.
CI  - Copyright (c) 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Fass, Ronnie
AU  - Fass R
AD  - Digestive Health Center, MetroHealth System, Cleveland, Ohio.
FAU - Zerbib, Frank
AU  - Zerbib F
AD  - Department of Gastroenterology, Bordeaux University Hospital, Universite de 
      Bordeaux, Bordeaux, France.
FAU - Gyawali, C Prakash
AU  - Gyawali CP
AD  - Division of Gastroenterology, Washington University School of Medicine, St Louis, 
      Missouri. Electronic address: cprakash@dom.wustl.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200201
PL  - United States
TA  - Gastroenterology
JT  - Gastroenterology
JID - 0374630
RN  - 0 (Gastrointestinal Agents)
SB  - IM
MH  - Benchmarking
MH  - Complementary Therapies
MH  - *Digestive System Surgical Procedures/adverse effects
MH  - *Endoscopy, Gastrointestinal/adverse effects
MH  - Evidence-Based Medicine
MH  - Gastroesophageal Reflux/diagnosis/etiology/*therapy
MH  - Gastrointestinal Agents/adverse effects/*therapeutic use
MH  - *Healthy Lifestyle
MH  - Heartburn/diagnosis/etiology/*therapy
MH  - Humans
MH  - Psychotherapy
MH  - *Risk Reduction Behavior
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Ambulatory Reflux Monitoring
OT  - Functional Heartburn
OT  - High-Resolution Manometry
OT  - Nonerosive Reflux Disease
EDAT- 2020/02/06 06:00
MHDA- 2021/02/18 06:00
CRDT- 2020/02/05 06:00
PHST- 2019/12/03 00:00 [received]
PHST- 2020/01/14 00:00 [revised]
PHST- 2020/01/23 00:00 [accepted]
PHST- 2020/02/06 06:00 [pubmed]
PHST- 2021/02/18 06:00 [medline]
PHST- 2020/02/05 06:00 [entrez]
AID - S0016-5085(20)30128-1 [pii]
AID - 10.1053/j.gastro.2020.01.034 [doi]
PST - ppublish
SO  - Gastroenterology. 2020 Jun;158(8):2286-2293. doi: 10.1053/j.gastro.2020.01.034. 
      Epub 2020 Feb 1.