Differential diagnosis and treatment of heartburn in practice of a family doctor | Ukrainian Medical Journal

The article at the modern scientific level provides the information on the prevalence of heartburn and reveals its pathogenetic mechanisms. Particular attention is paid to the phenomenon of refractory heartburn to therapy with proton pump inhibitors. A wide range of reasons for the absence of a clinical effect in treatment, related both to the patients themselves and with the presence of other pathological conditions in them, in particular, functional diseases — reflux hypersensitivity and functional heartburn, are considered. Diagnostic criteria for these diseases according to Roman criteria IV, as well as an algorithm for diagnostic and therapeutic measures, are provided to help the family doctor.

Published: 09.08.2019

References:

Almeida A.M., Martins L.A., Cunha P.L. et al. (2017) Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil. Arq. Gastroenterol., 54(1): 46–50.
Ates F., Francis D.O., Vaezi M.F. (2014) Refractory gastroesophageal reflux disease: advances and treatment. Expert. Rev. Gastroenterol. Hepatol., 8(6): 657–667.
Chiriia I., Petrariu P., Drug V. et al. (2013) Epidemiology of gastroesophageal reflux and relationship with diet in adult urban population. J. Gasfroenterol. Hepatol., 28 (suppl. 3): 503.
Coyle C., Crawford G., Wilkinson J. et al. (2017) Randomised clinical trial: addition of alginate-antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms. Aliment. Pharmacol. Ther., 45(12): 1524–1533.
Dickman R., Maradey-Romero C., Gingold-Belfer R., Fass R. (2015) Unmet needs in the treatment of gastroesophageal reflux disease. J. Neurogastroenterol. Motil., 21(3): 309–319.
Domingues G., Moraes-Filho J.P.P., Fass R. (2018) Refractory heartburn: a challenging problem in clinical practice. Dig. Dis. Sci., 63(3): 577–582.
El-Serag H.B., Sweet S., Winchester C.C., Dent J. (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut, 63(6): 871–880.
Gyawali C.P., Kahrilas P.J., Savarino E. et al. (2018) Modern diagnosis of GERD: the Lyon Consensus. Gut, 67(7): 1351–1362.
Huang F.L., Yu S.J. (2018) Esophageal cancer: Risk factors, genetic association, and treatment. Asian J. Surg., 41(3): 210–215.
Huerta-Iga F., Bielsa-Fernández M.V., Remes-Troche J.M. et al. (2016) Diagnóstico y tratamiento de la enfermedad por reflujo gastroesofágico: recomendaciones de la Asociación Mexicana de Gastroenterología. Revista de Gastroenterología de México, 81(4): 208–222.
Huerta-Iga F., Bielsa-Fernández M.V., Remes-Troche J.M. et al.; en representación del Grupo para el estudio de la ERGE 2015 (2016) Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. Rev. Gastroenterol. Mex., 81(4): 208–222.
Kahrilas P.J., Jonsson A., Denison H. et al. (2012) Regurgitation is less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease. Clin. Gastroenterol. Hepatol., 10: 612–619.
Kahrilas P.J., Shaheen N.J., Vaezi M.F. et al.; American Gastroenterological Association (2008) American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1383–1391.
Manabe N., Haruma K., Ito M. et al. (2012) Efficacy of adding sodium alginate to omeprazole in patients with nonerosive reflux disease: a randomized clinical trial. Dis. Esophagus., 25(5): 373–380.
Martinez S.D., Malagon I.B., Garewal H.S. et al. (2003) Non-erosive reflux disease (NERD) — acid reflux and symptom patterns. Aliment. Pharmacol. Ther., 17(4): 537–545.
Martinucci I., Natilli M., Lorenzoni V. et al. (2018) Gastroesophageal reflux symptoms among Italian university students: epidemiology and dietary correlates using automatically recorded transactions. BMC Gastroenterol., 18(1): 116.
Mermelstein J., Chait M.A., Chait M.M. (2018) Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin. Exp. Gastroenterol., 11: 119–134.
Ness-Jensen E., Hveem K., El-Serag H., Lagergren J. (2016) Lifestyle intervention in gastroesophageal reflux disease. Clin. Gastroenterol. Hepatol., 14(2): 175–182.
Phupong V., Hanprasertpong T. (2015) Interventions for heartburn in pregnancy. Cochrane Database Syst. Rev., 9: 11379.
Reimer C., Ladrup A.B., Smith G. et al. (2016) Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Aliment. Pharmacol. Ther., 43(8): 899–909.
Richter J.E. (2007) How to manage refractory GERD. Nat. Clin. Pract. Gastroenterol. Hepatol., 4: 658–664.
Rohof W., Bennink R., Boeckxstaens G. (2012) Effect of PPIs on the size, position and acidity of the postprandial acid pocket. Gastroenterol., 142: 92.
Rohof W., Bennink R., Smout A. et al. (2013) An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin. Gastroenterol. Hepatol., 11(12): 1585–1591.
Savarino E., Bredenoord A.J., Fox M. et al.; International Working Group for Disorders of Gastrointestinal Motility and Function (2017) Expert consensus document: Advances in the physiological assessment and diagnosis of GERD. Nat. Rev. Gastroenterol. Hepatol., 14(11): 665–676.
Savarino E., de Bortoli N., Zentilin P. et al. (2012) Alginate controls heartburn in patients with erosive and nonerosive reflux disease. World J. Gastroenterol., 18: 4371–4378.
Savarino E., Marabotto E., Bodini G. et al. (2017) Epidemiology and natural history of gastroesophageal reflux disease. Minerva Gastroenterol. Dietol., 63(3): 175–183.
Smith H. (2017) Heartburn, gastro-oesophageal reflux disease and non-erosive reflux disease. S. Afr. Pharm. J., 84(3): 24–27.
Spantideas N., Drosou E., Bougea A., Assimakopoulos D. (2016) Gastroesophageal reflux disease symptoms in the Greek general population: prevalence and risk factors. Clin. Exp. Gastroenterol., 9: 143–149.
Strugala V., Bassin J., Swales V.S. et al. (2012) Assessment of the safety and efficacy of a raft-forming alginate reflux suppressant (Liquid Gaviscon) for the treatment of heartburn during pregnancy. ISRN Obstet. Gynecol., 2012: 481870.
Subramanian C.R., Triadafilopoulos G. (2015) Refractory gastroesophageal reflux disease. Gastroenterol. Rep., 3(1): 41–53.
Takeshima F., Hashiguchi K., Onitsuka Y. (2015) Clinical characteristics of patients with gastroesophageal reflux disease refractory to proton pump inhibitors and the effects of switching to 20 mg esomeprazole on reflux symptoms and quality of life. Med. Sci. Monit., 21: 4111–4121.
Thomas E., Wade A., Crawford G. et al. (2014) Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) — a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment. Pharmacol. Ther., 39(6): 595–602.
Woodland P., Batista-Lima F., Lee C. et al. (2015) Topical protection of human esophageal mucosal integrity. Am. J. Physiol. Gastrointest. Liver Physiol., 308(12): 975–980.
Yamasaki T., Fass R. (2017) Reflux hypersensitivity: a new functional esophageal disorder. J. Neurogastroenterol. Motil., 23(4): 495–503.

Avdeev V.G. (2015) Mesto alginatov v terapii gastroezofagealnoy reflyuksnoy bolezni. arh., 5: 118–121.
Galiev Sh.Z., Amirov N.B. (2015) Duodenogastralnyiy reflyuks kak prichina razvitiya reflyuks-gastrita. sovr. klin. med., 8(2): 50–61.
Grishechkina I.A., Kusakina A.A., Miermanova M.K. (2015) Osobennosti techeniya gastroezofagealnoy reflyuksnoy bolezni u beremennyih. Molodoy uchenyiy, 13: 263–265.
Davyidkin I.L., Osadchuk A.M., Gritsenko T.A., Kurtov I.V. (2017) Refrakternaya forma gastroezofagealnoy reflyuksnoy bolezni: evolyutsiya predstavleniy. Nauka i innovatsii v meditsine, 1(5): 24–30.
Domashnieva N.O., Mosiichuk L.M., Zak M.Iu. ta in. (2009) Atrofichnyi hastryt: zhovchni kysloty shlunkovoho soku ta morfo-funktsionalni zminy slyzovoi obolonky shlunka pry riznykh stupeniakh vyrazhenosti atrofichnoho protsesu. Hastroenterol. Mizhvid. zb., 42. Porohy, Dnipropetrovsk, s. 204–208.
Zagorskiy S.E. (2013) Chastota tipichnyih simptomov gastroezofagealnoy reflyuksnoy bolezni u detey starshego vozrasta i podrostkov Respubliki Belarus, prozhivayuschih v razlichnyih usloviyah urbanizatsii. Prakt. med., 6(75) 119–121.
Zaychenko G.V., Ravshanov T.B. (2016) Simptomaticheskoe lechenie izzhogi: chto novogo? (vzglyad klinicheskogo farmakologa). Ukr. med. chasopis, 1(111): 73–75 (https://www.umj.com.ua/article/92557).
Isakov V.A., Morozov S.V., Stavraki E.S., Komarov R.M. (2008) Analiz rasprostranennosti izzhogi: natsionalnoe epidemiologicheskoe issledovanie vzroslogo gorodskogo naseleniya (ARIADNA). Eksperiment. klin. gastroenterol., 1: 20–30.
Kochueva M.N. (2015) Gastroezofagealnaya reflyuksnaya bolezn: k voprosu o povyishenii effektivnosti terapii. Ukr. med. chasopis, 3(107): 59–62 (https://www.umj.com.ua/article/87483).
Livzan M.A., Lyalyukova E.A. (2015) Gastroezofagealnaya reflyuksnaya bolezn, refrakternaya k terapii ingibitorami protonnoy pompyi. Klinicheskie nablyudeniya. Lech. vrach, 8: 18–21.
Mosiichuk L.M., Kushnirenko I.V., Simonova O.V., Ostrovskyi O.S. ta in. (2009) Stan kyslotoutvoriuiuchoi funktsii shlunka ta rol duodenohastralnoho refliuksu u formuvannia perebudovnykh yii zmin. Hastroenterol. Mizhvid. zb., 42. Porohy, Dnipropetrovsk, s. 100–108.
Osadchuk A.M., Davyidkin I.L., Gritsenko T.A. i dr. (2017) Sindrom izzhogi. Aktualnyie voprosyi patogeneza, differentsialnoy diagnostiki i lecheniya. Sovr. probl. nauki obrazov., 5 (https://www.science-education.ru/ru/article/view?id=26974).
Osadchuk M.M., Lyisov N.A., Osadchuk T.K. (2015) Izzhoga — epidemiya XXI veka. Meditsinskiy alfavit. Prakt. gastroenterol., 2(15): 42–47.
Ostrohliad A.V. (2006) Pershyi dosvid vyvchennia epidemiolohii hastroezofahealnoi refliuksnoi khvoroby v Ukraini. Suchas. hastroenterol., 1(27): 30–32.
Simonenkov V.I., Tihonov S.V., Lischuk N.B. (2017) Simptom izzhogi v svete Rimskih kriteriev IV. Ref. med. zhurn., 10: 691–696.
Tkach S.M. (2015) Renessans alginatov i antatsidov v lechenii gastroezofagealnoy reflyuksnoy bolezni. Suchas. gastroenterol., 2: 57–65.
Truhan D.I., Grishechkina I.A. (2016) Terapiya izzhogi beremennyih: fokus na alginatyi. Consilium Medicum, 18(6): 29–34.
Sheptulin A.A., Kaybyisheva V.O. (2017) Funktsionalnaya izzhoga i giperchuvstvitelnost pischevoda k reflyuksu (po materialam Rimskih kriteriev funktsionalnyih zabolevaniy pischevoda IV peresmotra). Ros. zhurn. gastroenterol. Gepatol. koloproktol., 27(2): 13–18.