Conditions / Functional Heartburn
Functional Heartburn / Esophageal Hypersensitivity
Affects an estimated ~30% of heartburn patients
Overview
Functional heartburn occurs when patients have typical heartburn symptoms but endoscopy shows no erosions and pH monitoring shows normal acid levels. The esophagus is hypersensitive — perceiving normal sensations as painful. The brain-gut axis is strongly involved.
How it's diagnosed
Normal endoscopy + normal pH monitoring + normal esophageal manometry = functional heartburn. Rome IV criteria. This is an exclusion diagnosis.
Triggers
- Stress and anxiety (primary driver)
- All typical dietary triggers
- Sleep deprivation
- Hormonal fluctuations
Symptoms
- Heartburn that doesn't respond well to PPIs
- Chest pain
- Symptoms correlate strongly with stress
- Often worse before major life events
Complications if untreated
- Reduced quality of life
- Anxiety and depression from chronic symptoms
- Over-reliance on ineffective PPIs
Immediate relief
- Deep diaphragmatic breathing exercises
- Cognitive reframing techniques
- Antacids for symptomatic relief
Long-term management
- Low-dose tricyclic antidepressants (neuromodulators) — highly effective
- CBT (cognitive behavioral therapy)
- Mindfulness-based stress reduction
- Hypnotherapy for esophageal hypersensitivity
Diet
Standard GERD diet but emphasizing stress-reduction meals. Eat slowly, in calm environments. Mindful eating is as important as what you eat.
When to see a doctor
Consult gastroenterologist AND consider referral to psychologist with GI experience (psychogastroenterologist). This is a real condition, not "in your head."
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