Functional heartburn: what it is and how to treat it.

Functional heartburn is considered one of the most common functional esophageal disorders. The disorder is more common in young women and is associated with other functional bowel disorders and psychological co-morbidity, primarily somatization. The etiology of functional heartburn remains unknown. Most patients, however, demonstrate esophageal hypersensitivity. Functional heartburn has been identified as the main cause for proton pump inhibitor (PPI) failure in patients with heartburn. Treatment is still a challenge, and patients should be started with PPI treatment. In non-responders, escalation of the PPI dose could be attempted and, if unsuccessful, pain modulators should be prescribed.