A randomized controlled trial of paroxetine for noncardiac chest pain. Many of the original studies, using the Rome II criteria for functional heartburn, did not distinguish between the 2 groups of patients.
According to the Rome IV criteria, diagnosis of a functional esophageal disorder requires having symptoms for the past 3 months with symptom onset at least 6 months before diagnosis.
doi: 10.1111/nmo.13573. Esophageal hypersensitivity is defined as the perception of non-painful esophageal stimuli as being painful and the perception of painful esophageal stimuli as being more painful.Other proposed underlying mechanisms for reflux hypersensitivity include altered central processing of esophageal stimuli, hypervigilance, altered autonomic activity, and psychological commodity (What is unique about patients with reflux hypersensitivity as compared to those with functional heartburn is their sensitivity to physiological amounts of gastroesophageal reflux. Moreover, therapies are mainly empiric in nature and, in many cases, of limited value.Known in the past as the hypersensitive esophagus group, reflux hypersensitivity is a new functional esophageal disorder that was introduced for the first time by Rome IV.Based on the Rome IV criteria, the definition of reflux hypersensitivity includes retrosternal symptoms including heartburn or chest pain, normal endoscopy, and absence of eosinophilic esophagitis or major esophageal motor disorders (achalasia, esophagogastric junction outflow obstruction, distal esophageal spasm, jackhammer esophagus, and absent contractility) as the etiology of symptoms, and evidence of triggering of symptoms by reflux events despite normal acid exposure on pH or pH-impedance monitoring (The definition of reflux hypersensitivity emphasizes the need for positive symptom indexes to acidic or nonacidic reflux in the context of normal esophageal acid exposure, regardless if reflux assessment is done off or on therapy.Studies have demonstrated that up to 70% of patients with heartburn have normal endoscopy.Several recent studies, using pH-impedance monitoring evaluated the prevalence of reflux hypersensitivity.
Neurogastroenterol Motil. Curr Treat Options Gastroenterol. Konturek, PC, Brzozowski, T, and Konturek, SJ (2011). I can now eat berries again but I'm planning on staying on the "maintenance phase" …
Savarino et alRegarding acid sensitive receptors, it was shown by immunostaining that transient receptor potential vanilloid-1 (TRPV1)-positive nerve fibers are increased in erosive esophagitis mucosa. Ostovaneh, MR, Saeidi, B, and Hajifathalian, K (2014). The Test Was Done Off TreatmentJournal of Neurogastroenterology and Motility 2017; 23(4): 495-503 Reflux Hypersensitivity: A New Functional Esophageal DisorderDivision of Gastroenterology and Hepatology, Esophageal and Swallowing Center, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA© The Korean Society of Neurogastroenterology and Motility. Rome III: the functional gastrointestinal disorders. Am J Clin Hypn.
Symptoms arising from the esophagus are very common among patients seeking medical care.
Originally, it was noted that the reflux hypersensitivity group is sensitive to physiologic levels of acidic reflux. Hershcovici, T, and Fass, R (2010). They include medical, endoscopic, and surgical interventions that are also used to treat GERD. Silverchair Information Systems Rome II: the functional gastrointestinal disorders. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. Additionally, the limited understanding of the pathophysiologic basis of these conditions commonly results in frustration of patients as well as physicians. J Psychosom Res. The latter may include psychologists or psychiatrists, alternative/complimentary medicine therapists, acupuncturists as well as other experts in functional medicine.Because patients with reflux hypersensitivity have symptoms that are triggered by reflux events, anti-reflux therapeutic modalities have been considered as first line therapy. Am J Gastroenterol. J Dig Dis. Gut. Watson, RG, Tham, TC, Johnston, BT, and McDougal, NI (1997).
The introduction of the pH-impedance test revealed esophageal sensitivity to non-acid reflux as well in the context of normal esophageal acid exposure. These are a heterogenous group of disorders which, despite having characteristic symptom profiles attributable to esophageal pathology, fail to demonstrate any structural, … J Neurogastroenterol Motil. Esophageal hypersensitivity refers to a sensory dysfunction in which patients experience discomfort or pain at thresholds that are significantly lower than those experienced by healthy controls. All rights reserved.Drossman, DA (2016). Miwa, H, Kondo, T, Oshima, T, Fukui, H, Tomita, T, and Watari, J (2010). Psychosom Med.