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  • Title: Functional heartburn vs. non-erosive reflux disease: similarities and differences.
    Author: Hershcovici T, Zimmerman J.
    Journal: Aliment Pharmacol Ther; 2008 Jun 01; 27(11):1103-9. PubMed ID: 18315589.
    Abstract:
    BACKGROUND: Bowel symptoms have been associated with non-erosive reflux disease (NERD). However, their role in functional heartburn (FH) has not been established. AIMS: To characterize bowel symptoms in FH and NERD patients, and investigate their role as predictors of severity of reflux symptoms. METHODS: A prospective study of patients with normal upper endoscopy undergoing a 24-h oesophageal pH monitoring for the evaluation of reflux symptoms. Patients with oesophageal acid exposure <3.1% and a symptom index <50% were classified as FH (n = 60), while those with oesophageal acid exposure >4% were defined as NERD (n = 160). Symptom severity was scored on validated scales. RESULTS: In FH, a female predominance was noted (P < 0.001). Reflux symptoms were scored higher in NERD patients (P < 0.001) while bowel symptoms were similarly scored in the two groups. In both groups, severity of reflux symptoms was independently associated with a composite score on the bowel scales (P < 0.001) and was not predicted by oesophageal acid exposure. In FH, reflux symptom severity was inversely related to age (P = 0.03), while in NERD, the opposite was true (P = 0.01). CONCLUSIONS: In both FH and NERD, bowel symptoms were the strongest predictors of reflux symptoms severity. A female preponderance, and an opposite relationship between reflux symptom severity and age, indicate that FH and NERD may be distinct entities.
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