Demographic, Clinical, and Psychological Characteristics of the Heartburn Groups Classified Using the Rome III Criteria and Factors Associated with the Responsiveness to Proton Pump Inhibitors in the Gastroesophageal Reflux Disease Group

Abstract

Background/Aims: The diagnostic criteria for nonerosive reflux disease (NERD) and functional heartburn (FH) have been changed. We investigated demographic, clinical, and psychological characteristics of the heartburn groups classified using the Rome III criteria and factors associated with the responsiveness to proton pump inhibitors (PPIs) in the gastroesophageal reflux disease (GERD) group. Methods: Ninety-five patients with heartburn underwent endoscopy, 24-hour esophageal pH-metry and then a PPI test. NERD was diagnosed when % time with pH <4 was >4%, a symptom index (SI) ≥50% or a positive PPI test in patients without erosive esophagitis. Patients without such findings were classified as FH. Results: Thirty-six patientshad erosive reflux disease (ERD), 36 had NERD, and 23 had FH. The proportion of males was significantly higher in ERD than in FH. Atypical symptoms and IBS were more prevalent in FH than in ERD. Anxiety was more prevalent in FH than in NERD. The prevalence of pathologic acid reflux, a positive SI and a positive PPI test was similar between ERD and NERD patients. In the ERD and NERD groups, depression was independently associated with nonresponsiveness to PPIs. Conclusions: FH is a different entity from ERD or NERD, particularly in terms of gender, acid reflux patterns, psychological profiles, and the responsiveness to PPIs.