OBJECTIVES:Patients with heartburn and normal upper gastrointestinal endoscopy, normal oesophageal acid exposure, no symptom-reflux association and who fail to respond to a proton-pump inhibitor are classified as having functional heartburn (FH). This study aimed (i) to characterize the symptoms and functional abnormalities of patients with FH and (ii) to describe their clinical outcome. MATERIALS AND METHODS:Among all patients referred for 24 h multichannel intraluminal impedance-pH (MII-pH), patients with FH were identified. The clinical characteristics and high-resolution oesophageal pressure topography recordings of FH patients were analyzed at the time of the 24-h MII-pH test. A symptom-related and health-related quality-of-life questionnaire was then sent to FH patients to assess the long-term outcome. RESULTS:Forty patients fulfilled the criteria for FH, representing 8.5% of the referred population. Twenty-two months after initial testing, 66% of patients still suffered from heartburn. The rate of mixed reflux (liquid/gas) was higher in patients with persisting heartburn at the final evaluation (63 vs. 50%, P=0.04). Sixty-six per cent of patients had one or more manometric abnormalities. Acid clearance time in MII-pH was significantly higher in patients with weak peristalsis than patients with normal peristalsis (60 ± 45 vs. 31 ± 19 s, P=0.03). A high rate of mixed reflux and/or a manometric abnormality were associated with a higher risk of persistent heartburn. CONCLUSION:FH is a chronic disorder with persisting symptoms in two-thirds of patients. An increased rate of mixed reflux and/or the presence of manometric abnormalities are associated with a higher risk of persisting symptoms and may help to identify the population with unmet therapeutic needs.

译文

目的:患有胃灼热和正常上消化道内窥镜检查,正常食道酸暴露,无症状-反流关联且对质子泵抑制剂无反应的患者被归类为功能性胃灼热(FH)。这项研究旨在(i)表征FH患者的症状和功能异常,以及(ii)描述其临床结局。
材料与方法:在所有接受24 h多通道管腔内阻抗pH(MII-pH)治疗的患者中,均鉴定出FH患者。在24小时MII-pH测试时分析了FH患者的临床特征和高分辨率的食管压力地形图记录。然后将症状相关和健康相关的生活质量调查表发送给FH患者,以评估其长期预后。
结果:40例患者符合FH标准,占推荐人群的8.5%。初始测试后的22个月,仍有66%的患者患有胃灼热。在最终评估中,持续性烧心患者的混合反流(液体/气体)比率更高(63%vs. 50%,P = 0.04)。 66%的患者有一个或多个压力异常。蠕动较弱的患者在MII-pH中的酸清除时间明显长于正常蠕动的患者(60±45 vs. 31±19 s,P = 0.03)。混合反流率高和/或测压异常与持续性烧心的风险较高相关。
结论:FH是一种慢性疾病,在三分之二的患者中持续存在症状。混合反流率的增加和/或压力异常的存在与持续存在症状的风险较高有关,可能有助于确定治疗需求未得到满足的人群。

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