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Am J Gastroenterol. 2016 Dec;111(12):1711-1717. doi: 10.1038/ajg.2016.432. Epub 2016 Sep 20.

Functional Heartburn Overlaps With Irritable Bowel Syndrome More Often than GERD.

Author information

1
Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy.
2
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
3
Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padua, Italy.
4
Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy.
5
Jagiellonian University, Cracow, Poland.
6
Department of Surgery, Division of Surgery, Second University of Naples, Naples, Italy.
7
Department of Statistics, University of Bologna, Bologna, Italy.
8
Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy.
9
Department of Internal Medicine, Division of Pharmacology and Chemotherapy, University of Pisa, Pisa, Italy.

Abstract

OBJECTIVES:

We aimed to evaluate the prevalence of irritable bowel syndrome (IBS) in patients with typical reflux symptoms as distinguished into gastroesophageal reflux disease (GERD), hypersensitive esophagus (HE), and functional heartburn (FH) by means of endoscopy and multichannel intraluminal impedance (MII)-pH monitoring. The secondary aim was to detect pathophysiological and clinical differences between different sub-groups of patients with heartburn.

METHODS:

Patients underwent a structured interview based on questionnaires for GERD, IBS, anxiety, and depression. Off-therapy upper-gastrointestinal (GI) endoscopy and 24 h MII-pH monitoring were performed in all cases. In patients with IBS, fecal calprotectin was measured and colonoscopy was scheduled for values >100 mg/kg to exclude organic disease. Multivariate logistic regression analysis was performed to identify independent risk factors for FH.

RESULTS:

Of the 697 consecutive heartburn patients who entered the study, 454 (65%) had reflux-related heartburn (GERD+HE), whereas 243 (35%) had FH. IBS was found in 147/454 (33%) GERD/HE but in 187/243 (77%) FH patients (P<0.001). At multivariate analysis, IBS and anxiety were independent risk factors for FH in comparison with reflux-related heartburn (GERD+HE).

CONCLUSIONS:

IBS overlaps more frequently with FH than with GERD and HE, suggesting common pathways and treatment. HE showed intermediate characteristic between GERD and FH.

PMID:
27644732
DOI:
10.1038/ajg.2016.432
[Indexed for MEDLINE]

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