OVERVIEW
Heartburn is a common clinical symptom. Heartburn can be functional or organic. Functional heartburn is defined as recurrent episodes of retrosternal burning sensation in the absence of pathologic gastroesophageal reflux or pathologically based gastric or esophageal dynamics or structural abnormalities. Functional heartburn is strongly associated with high anxiety, emotional instability, and low social support, independent of feeding and body position. Most scholars believe that a high degree of visceral sensitivity is important in the development of the condition. Patients with functional heartburn may have acid reflux during symptomatic episodes but have normal esophageal acid exposure times on 24-hour esophageal pH monitoring. Functional heartburn is characterized by a heartburn sensation that is often pronounced during the daytime symptoms and may also be accompanied by belching, regurgitation, bloating, epigastric discomfort, and early satiety.
Etiology
The etiology and pathophysiologic mechanisms of functional heartburn are unknown. It is currently thought to be related to acid reflux, hypersensitivity of the esophagus and psychological factors.
Symptoms
Patients with functional heartburn are characterized by a heartburn sensation that is often evident in daytime symptoms, but can also be accompanied by belching, regurgitation, bloating, epigastric discomfort, early satiety and other symptoms. In severe cases, it manifests as pain, which may extend to the forehead and neck, and may be exacerbated by lying down or forward bowing position. It is prone to occur after a full meal, and aspirin, white potatoes, coffee, and strong tea can induce or aggravate symptoms. It can be relieved by upright position, drinking water or taking oral acid-controlling drugs.
Examination
1. Endoscopy
To understand the esophageal mucosa, observe whether there is reflux esophagitis, esophageal ulcer and esophageal space-occupying lesions.
2. Esophageal manometry
To measure the pressure of lower esophageal sphincter and the movement of esophageal body.
3. Esophageal acid titration test
This test is not commonly used and is used to determine whether the sensitivity of the esophagus to chemical stimuli has increased.
Diagnosis
Functional heartburn must meet all of the following criteria:
1. burning-like retrosternal discomfort or pain.
2. no evidence of esophageal acid reflux causing symptoms.
3. absence of esophageal dyskinesia with histopathologic abnormalities.
Symptoms have been present for at least 6 months prior to diagnosis and symptoms have met the above criteria for the last 3 months.
Treatment
1. General treatment
Avoid overeating, avoid stimulating foods, avoid lying down immediately after meals, and avoid increasing intra-abdominal pressure. Keep the clothes loose and the bowels unobstructed, actively prevent and control respiratory infections, so as not to increase the intra-abdominal pressure by coughing violently. Raise the head of the bed when sleeping at night, do not eat too much, control obesity, and maintain an optimistic attitude. Once heartburn occurs, you can eat or drink a small amount of water to neutralize or dilute the gastric acid in the lower esophagus, which can temporarily relieve heartburn symptoms.
2. Medications
(1) Antacids, mucosal protectants, aluminum hydroxide, magnesium aluminum carbonate, teprenone (Schweser), Rebapatide (Membrane Gustav), aluminum sulfate, Simethicone, bismuth pectinate, etc.
(2) Agonist drugs: Domperidone, Mosapride, Itopride, etc.
(3) Acid-suppressing drugs include H2 receptor antagonists (cimetidine, ranitidine, famotidine, etc.), proton pump inhibitors (such as omeprazole, lansoprazole, pantoprazole, esomeprazole magnesium, etc.).
(4) Anxiolytics Anxiolytics may be used in patients with a tendency to anxiety or depression.