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Functional heartburn in patients with PPI-refractory heartburn

A study published ahead of print in the Alimentary Pharmacology & Therapeutics examines histomorphological differentiation of non-erosive reflux disease and functional heartburn in patients with PPI-refractory heartburn.

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Proton pump inhibitor-refractory heartburn may be due to persistent gastro-esophageal reflux, esophageal hypersensitivity or functional heartburn.

The differentiation between non-erosive reflux disease and functional heartburn may be very difficult.

However, this differentiation is important for appropriate therapeutic management.

Dilated intercellular spaces, papillary elongation and basal cell hyperplasia can be all assessed by light microscopy.

Whether these mucosal abnormalities allow the differentiation of non-erosive reflux disease from functional heartburn in proton pump inhibitor-refractory patients is uncertain.

Dr Kandulski and colleagues from Germany assessed histopathological findings by light microscopy in patients with refractory heartburn to differentiate non-erosive reflux disease from functional heartburn.

The research team evaluated 62 patients with proton pump inhibitor-refractory symptoms who underwent esophagogastroduodenoscopy, and multichannel intraluminal impedance and pH monitoring (MII-pH) after pausing proton pump inhibitor medication for 2 weeks before investigation.

The team analyzed 25 subjects without upper gastrointestinal symptoms as controls.

Symptom assessment was based on the reflux disease questionnaire. 

Biopsies were taken 35 cm above the gastro-esophageal junction.

The most significant difference was found for dilated intercellular spaces
Alimentary Pharmacology & Therapeutics

Dilated intercellular spaces, papillary elongation, basal cell hyperplasia and infiltration of immune cells were evaluated and a sum score was calculated.

Based on endoscopy and MII-pH, GERD was diagnosed in 43 patients non-erosive reflux disease, and functional heartburn in 19 patients.

There was no difference in symptoms between the groups.

Each individual histopathological item was different between the groups.

Between non-erosive reflux disease and functional heartburn, the most significant difference was found for dilated intercellular spaces, and the histopathological sum score.

Dr Kandulski's team concluded, "These findings suggest that esophageal biopsies are useful to differentiate non-erosive reflux disease from functional heartburn."

"Increased dilated intercellular spaces and a histological sum score are the most significant histopathological abnormalities in non-erosive reflux disease as compared with functional heartburn."

Aliment Pharmacol Ther 2013: DOI: 10.1111/apt.12428
19 August 2013

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