Chapter 17 - Functional esophageal chest pain, functional heartburn and reflux hypersensitivity

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Functional chest pain, functional heartburn and reflux hypersensitivity are three distinct functional esophageal disorders as defined by Rome IV criteria. While the pathophysiology of each of these disorders is likely multifactorial, the evidence suggests they are linked by esophageal hypersensitivity and abnormal processing of esophageal stimuli. In order to diagnose these functional conditions, exclusion of active pathological gastroesophageal reflux or a major esophageal motor disorder is necessary, and the patient must have ambulatory reflux testing with an evaluation of symptom correlation. After diagnosis, there are a variety of treatment options to consider, including neuromodulators as well as complementary and alternative treatments. For reflux hypersensitivity, further attempts at acid suppression can be considered, as well as anti-reflux procedural treatment, though with limited evidence any invasive treatments should be cautiously approached. This chapter highlights the distinct disorders of functional chest pain, functional heartburn and reflux hypersensitivity with their current relevant recommended diagnostic and treatment approaches.