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Introduction

A great percentage of patients with typical reflux symptoms, after proper evaluation do not have Gastro-esophageal reflux disease (GERD) and diagnosed with Functional Heartburn (FH) or Reflux hypersensitivity (RH). Both are characterized by normal acid exposure time (AET) though RH shows a positive correlation of symptoms to reflux episodes and may be benefited by PPI. Differences in various manometric and pH-impedance metrics have been observed. Positivity of Symptomatic Index (SI) and/or Symptom associated Probability (SAP) is used for RH diagnosis though experts support that concordance of both should be adopted.

Aims & Methods

We assessed differences among patients with RH and FH as also among patients with RH and concordance of SI or SAP or not. Consecutive patients with typical reflux symptoms without previous GERD diagnosis, submitted simultaneously to Ph-Impedance off PPI and High Resolution Manometry were included. Self-response to PPI was evaluated. Patients showing SI and/or SAP positivity were considered having RH and further classified to definite RH if both SI/SAP were positive and indefinite if only one was positive.

Results

Totally 2659 patients (M/F: 35.6%/64.7%, mean age: 45 ±14) were included. Final diagnosis was; FH:21.8%, RH:29.3% (definite:14.3%/indefinite:15%), GERD:36% and inconclusive GERD:12.9%. Patients with RH showed increased mean Distal Contractile Interval (DCI), AET, number of reflux episodes and episodes with proximal extent. They also showed numerically but not statistical significantly increased rates of Lower Esophageal Sphincter (LES) hypotension, ineffective esophageal motility/absent peristalsis as also Esophago-gastric Junction (EGJ) anatomical type 2/3, Mean Nocturnal Baseline Impedance (MNBI) and PPI responsiveness in comparison to patients with FH. Patients with definite RH showed increased mean DCI, AET, total number of reflux episodes, refluxes with proximal extent and EGJ anatomical type 2/3 as also numerically but not statistical significantly increased rates of PPI responsiveness vs indefinite RH. Moreover they showed statistical significant increased rate of PPI response vs patients with Functional Heartburn (p=0.031). Table 1

Table 1

	Functional Heartburn	Reflux Hypersensitivity (RH)	p	Definite RH		Indefinite RH	p
Total AET	1.12±0.94	1.65±0.96	<0.001	1.36±1.09		1.85±1.13	<0.001
Total reflux number	26±19	42±24	<0.001	32±19		50±29	<0.001
number of episodes with proximal extent	13±12	24±17	<0.001	16.1±13.2		28.7±18.4	<0.001
MNBI (3cm)	2016.1±1066.2	1872.1±608.7	0.893	1959±1515		1774.7±498.9	0.483
Esophago-Gastric Junction (EGJ) type 2/3	20.9%	27.1%	0.043	22.9%		31.1%	<0.001
Mean DCI	1061.9±1039.6	904.9±898.3	0.015	921.3±900.8		925.6±887.9	0.947
LES hypotension	42.5%	47.2%	0.165	45.8%		47.9%	0.305
Diagnosis of ineffective esophageal motility/absent contractility	33.8%	38.2%	0.170	34.2%		38.6%	0.207
PPI responsiveness	(137/330) 41.5%	(223/468)47.6%	0.168	104/229 (45.4%)	119/239 (49.8%)		0.356

Numerical values expressed as mean ± SD. EGJ type 2: separation of LES to Crural Diaphragm (CD) 1-3 cm, type 3: separation of LES to CD >3cm

Conclusion

Patients with RH and SI/SAP concordance differ from patients without. Some PPI responsiveness is frequent among patients with RH as also with FH and cannot discriminate those entities clinically, though a difference is observed when adopting a more strict RH definition.

REFLUX HYPERSENSITIVITY VS FUNCTONAL HEARTBURN. FOCUSING ON CHARACTERISTICS OF PATIENTS WITH REFLUX HYPERSENSITIVITY ACCORDING TO SYMPTOMS PERCEPTION MARKERS WITH A SPECIAL INTEREST IN PPI RESPONSE

Theodoros Voulgaris 1, Shintaro Hoshino 1, Etsuro Yazaki 1

1 Barts and The London School of Medicine and Dentistry, Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, United Kingdom