Functional heartburn vs. non-erosive reflux disease: similarities and differences

Aliment Pharmacol Ther. 2008 Jun 1;27(11):1103-9. doi: 10.1111/j.1365-2036.2008.03666.x. Epub 2008 Feb 28.


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.

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Endoscopy, Gastrointestinal
  • Female
  • Gastroesophageal Reflux / diagnosis*
  • Heartburn / diagnosis*
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Statistics as Topic