Functional heartburn and reflux hypersensitivity syndrome (according to the Rome-IV functional esophageal disease diagnostic criteria)

Abstract

Aim of review. To analyze the update to in the Rome-IV criteria for the functional heartburn and reflux hypersensitivity syndrome in comparison to the Rome-III criteria. Summary. The definition of functional heartburn in the Rome-IV criteria is updated by the statement according to which absence of response to the proton pump inhibitor therapy is indispensable feature to establishing the functional heartburn diagnosis. Reflux hypersensitivity of the esophagus that was initially considered as one of the forms of the non-erosive gastroesophageal reflux disease (NERD) in the new criteria system is included in the spectrum of functional esophageal diseases. The diagnostic algorithm for the patient presenting with heartburn, having normally looking esophageal mucosa at upper endoscopy, is given. Tricyclic antidepressants and selective serotonin reuptake inhibitors play the major role in the treatment of above-mentioned functional esophageal diseases. Conclusion. The basic change in the Rome-IV criteria of the functional esophageal diseases is addition of esophageal hypersensitivity syndrome to the reflux disease entity, that was initially considered as a form of NERD.