D Patel et al. Clin Gastroenterol Hepatol 2021; 19: 1314-26. Full text: Untangling Nonerosive Reflux Disease From Functional Heartburn. This is an excellent review.
Key points:
- PPI response: 56% for erosive reflux disease, 37% for NERD, and 25% for functional heartburn (FH) per Figure 3 (*”FH might be a placebo effect owing to short follow-up evaluation”
- Determination of abnormal acid exposure time (AET >6% in adults) is key in distinguishing NERD from FH which in turn helps with selection of treatment. NERD is notable for AET >6% in adults. Many patients with NERD may also have esophageal hypersensitivity
- Table 2 reviews efficacy of neuromodulators for functional esophageal disorders; these include TCAs, SNRIs, SSRIs, and other agents (eg. gabapentin)
Related blog posts:
- Gastroesophageal Reflux Phenotypes and “Where Rome, Lyon, and Montreal Meet”
- How Many Kids with Reflux Actually Have Reflux?
- How to Make a Study Look Favorable for Reflux Surgery Compared to Medical Treatment | gutsandgrowth
- How helpful is a pH-Impedance Study in Identifying Reflux-Induced Symptoms? | gutsandgrowth
- Impedance May Help in Borderline Reflux Disease Assessment | gutsandgrowth
- What’s Going On in Patients with Reflux Who Fail Proton Pump Inhibitors | gutsandgrowth
- Guidelines on Functional Heartburn
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