Feature Article

Is heartburn always reflux? An update on gastro-oesophageal reflux

Feature Article

Is heartburn always reflux? An update on gastro-oesophageal reflux

Anna Foley

Figures

© CHRISTY KRAMES
© CHRISTY KRAMES

Abstract

Diagnosis of gastro-oesophageal reflux disease (GORD) is centred on patient-driven symptom reporting. However, some functional disorders can be indistinguishable from GORD based on symptoms. Lack of appropriate management of these functional disorders can lead to poor therapeutic response and quality of life, inappropriate use of proton pump inhibitors and frustration for the patient and doctor.

Key Points

  • Heartburn is one of the most common symptoms in patients presenting to GPs and may have a considerable impact on a patient’s wellbeing.
  • The diagnosis of gastro-oesophageal reflux disease (GORD) is usually made clinically and a trial of a proton pump inhibitor (PPI) can be a pragmatic and helpful way of confirming this diagnosis.
  • Confirmatory tests including gastroscopy, pH, pH-impedance and manometry are often required, especially if there is failure to respond to standard PPI dosing, diagnostic uncertainty or concern about complications.
  • Symptoms of functional heartburn, reflux hypersensitivity and GORD can be clinically indistinguishable and further testing helps to clarify the diagnosis, reducing the risk of PPI overuse and promoting symptom improvement using functional treatment approaches.
  • Patients with documented GORD who fail to respond to standard PPI dosing may require escalated medical treatment and consideration for antireflux surgery.