Ans Pauwels

Opinion statement Functional heartburn and functional chest pain of presumed esophageal origin are characterized by symptoms suggesting an esophageal origin, but negative work-up on routine investigations, including ruling out gastroesophageal reflux disease. Visceral hypersensitivity is a potentially unifying pathophysiological concept, thought to underlie these disorders. In addition, there is important overlap with other functional disorders and psychiatric co-morbidity. This review summarizes current concepts on definition, diagnosis, and treatment options for functional heartburn and functional chest pain of presumed esophageal origin. Antidepressants are frequently used in these conditions, where they are presumed to act as neuromodulators of visceral hypersensitivity. There is a need for high-quality trials evaluating the efficacy of antidepressants and more specific neuromodulators, such as pregabalin, in functional esophageal disorders.

Extra-oesophageal symptoms of gastro-oesophageal reflux disease (GORD) are often studied, but remain a subject of debate. It has been clearly shown that there is a relationship between the extra-oesophageal symptoms chronic cough, asthma, laryngitis and dental erosion and GORD. Literature is abundant concerning reflux-related cough and reflux-related asthma, but much less is known about reflux-related dental erosions. The prevalence of dental erosion in GORD and vice versa, the prevalence of GORD in patients with dental erosion is high but the exact mechanism of reflux-induced tooth wear erosion is still under review.