‘Functional heartburn’: symptom for achalasia or hypertensive lower oesophageal sphincter?

Abstract

Sirs, With interest we read the article by Frazzoni et al.1 entitled ‘Pathophysiological characteristics of patients with non-erosive reflux disease differ from those of patients with functional heartburn’ which is published in the current issue of Alimentary Pharmacology and Therapeutics. The study adds important information concerning the pathophysiology underlying gastro-oesophageal reflux disease (GERD).2 Based on data obtained by symptoms (i.e. heartburn, acid regurgitation and chest pain) and upper gastrointestinal (GI) function testing – manometry [lower oesophageal sphincter (LES) resting pressure, oesophageal amplitude], 24 h pH-testing non-erosive GERD and functional heartburn may in fact be a different entities.1 However, in their paper the authors do not provide information on wet swallow induced LES relaxation and duration of LES relaxation.3 In addition, it is not clarified if patients with functional heartburn did have episodes of dysphagia. Thus the reader is not able to exclude if ‘functional heartburn’ may, at least in some patients, be because of functional disorders such as achalasia4 or hypertensive LES.3 We think that exclusion of such disorders is of major importance and it may accurately help to define those patients having ‘functional heartburn’.