Yamasaki Takahisa, O'Neil Jessica, Fass Ronnie
Dr Yamasaki is a research fellow at the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland, Ohio and a visiting scholar at Case Western Reserve University in Cleveland, Ohio. Ms O'Neil is a medical student at Case Western Reserve University. Dr Fass is the medical director of the Digestive Health Center, director of the Division of Gastroenterology and Hepatology, and head of the Esophageal and Swallowing Center at MetroHealth Medical Center, as well as a professor of medicine at Case Western Reserve University.
Gastroenterol Hepatol (N Y). 2017 Dec;13(12):725-734.
The definition of functional heartburn has been refined over the years. It is currently described, based upon Rome IV criteria, as typical heartburn symptoms in the presence of normal upper endoscopy findings (including normal biopsies), normal esophageal pH testing, and a negative association between symptoms and reflux events. Functional heartburn is very common, affecting women more than men, and with reflux hypersensitivity makes up the majority of heartburn patients who fail twice-daily proton pump inhibitor therapy. These disorders overlap with other functional gastrointestinal disorders and are often accompanied by psychological comorbidities. Diagnosis is made by using endoscopy with esophageal biopsies, wireless pH capsule, pH-impedance monitoring, and high-resolution esophageal manometry. Additional diagnostic tools that may be of value include magnification endoscopy, chromoendoscopy, narrow-band imaging, autofluorescence imaging, mucosal impedance, impedance baseline values, and histopathology scores. Functional heartburn is primarily treated with neuromodulators. Psychological intervention and complementary and alternative medicine may also play important roles in the treatment of these patients.
多年来，功能性烧心的定义不断完善。目前，根据罗马IV标准，功能性烧心被描述为：在上消化道内镜检查结果正常（包括活检正常）、食管pH测试正常以及症状与反流事件呈负相关的情况下出现典型烧心症状。功能性烧心非常常见，女性患者多于男性患者，并且与反流高敏反应一起构成了每日两次质子泵抑制剂治疗失败的烧心患者的大多数。这些病症与其他功能性胃肠疾病重叠，且常伴有心理合并症。诊断通过食管活检内镜检查、无线pH胶囊、pH-阻抗监测和高分辨率食管测压来进行。可能有价值的其他诊断工具包括放大内镜检查、色素内镜检查、窄带成像、自体荧光成像、黏膜阻抗、阻抗基线值和组织病理学评分。功能性烧心主要采用神经调节剂治疗。心理干预以及补充和替代医学在这些患者的治疗中也可能发挥重要作用。
