Psychological Comorbidity and Chronic Heartburn: Which Is the Chicken and Which Is the Egg?

Excerpt

During the last two decades, it has been recognized that patients reporting heartburn may not necessarily have gastroesophageal reflux disease (GERD) as the underlying cause of their symptoms [1]. Heartburn does not appear to be stimulus-specific, since numerous stimuli may provoke this symptom [2]. For example, either mechanical (intra-esophageal balloon distension) or chemical (mucosal acidification) can cause heartburn [3]. This scientific breakthrough enabled research groups to identify new disorders in which heartburn was the predominant symptom, such as functional heartburn and reflux hypersensitivity, which are not GERD-related but instead are included in the category of functional esophageal disorders [4]. Importantly, within the GERD group, there are 3 phenotypic presentations, all with heartburn as the predominant symptom: nonerosive reflux disease (NERD), erosive esophagitis, and Barrett’s esophagus [5]. Thus, there are currently 5 accepted disorders (3 GERD-related and 2 functional esophageal disorders) in which heartburn is the principal symptom. …