Review
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World J Gastroenterol. Sep 21, 2013; 19(35): 5787-5797
Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5787
Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome
Nicola de Bortoli, Irene Martinucci, Massimo Bellini, Edoardo Savarino, Vincenzo Savarino, Corrado Blandizzi, Santino Marchi
Nicola de Bortoli, Irene Martinucci, Massimo Bellini, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy
Edoardo Savarino, Division of Gastroenterology, University of Padua, 35100 Padua, Italy
Vincenzo Savarino, Division of Gastroenterology, University of Genoa, 16100 Genoa, Italy
Corrado Blandizzi, Division of Pharmacology and Chemotherapy, University of Pisa, 56124 Pisa, Italy
Author contributions: de Bortoli N, Martinucci I and Bellini M performed the literature review; de Bortoli N, Martinucci I and Blandizzi C drafted the paper; Savarino E, Savarino V and Marchi S performed the critical revision of the manuscript.
Correspondence to: Nicola de Bortoli, MD, Gastroenterology Unit, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. nick.debortoli@gmail.com
Telephone: +39-50-997395 Fax: +39-50-997398
Received: September 24, 2012
Revised: November 14, 2012
Accepted: December 25, 2012
Published online: September 21, 2013
Processing time: 361 Days and 9.9 Hours
Abstract

Several studies indicate a significant degree of overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). Likewise, both functional heartburn (FH) and IBS are functional digestive disorders that may occur in the same patients. However, data establishing a solid link between FH and IBS are lacking, mainly because the clinical definition of FH has undergone substantial changes over the years. The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS. In particular, several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH (as defined by the Rome III criteria) from GERD via pathophysiological investigations. Independent of these critical issues, there is preliminary evidence supporting a significant degree of FH-IBS overlap. This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications, particularly to distinguish FH from GERD. This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.

Keywords: Functional gastrointestinal disorders; Gastroesophageal reflux disease/Gastro-oesophageal reflux disease; Irritable bowel syndrome; Acidity (esophageal); Hypersensitivity