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Colegio de Medicina Interna de México.

2021, Number 2

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Med Int Mex 2021; 37 (2)

Refractory gastroesophageal reflux disease. When to suspect functional heartburn or reflux hypersensitivity?

Ramírez-del Pilar R, Ramos-Gómez MV, Navarro-Gerrard C, Paredes-Amenabar C

Language: Spanish
References: 29
Page: 221-229
PDF size: 377.37 Kb.


ABSTRACT

Refractory gastroesophageal reflux disease is defined as heartburn that persists after 8 weeks of optimal proton pump inhibitors treatment. Two of its main causes are functional heartburn and reflux hypersensitivity defined in accordance to Rome IV’s criteria, which are typical reflux signs and normal endoscopy (including biopsies), pH-impedance monitoring tests and high-resolution esophageal manometry. Functional heartburn has negative association indexes on the pH-impedance monitoring tests while reflux hypersensitivity has positive association indexes and both these pathologies represent more than 90% of all patients with heartburn that fail to a double dose proton pump inhibitors regime. They are more prevalent in middle aged women with other functional gastrointestinal disorders and they are associated to psychological comorbidities. Their treatment is based on neuromodulators such as tricyclic anti-depressants and selective serotonin reuptake inhibitors (SSRI). Surgical interventions may play a role in the treatment of reflux hypersensitivity but not in the case of functional heartburn.


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