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MeSH Review


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Disease relevance of Heartburn


High impact information on Heartburn

  • These studies suggest that LES dysfunction and gastroesophageal reflux, rather than gastric hypersection, are responsible for the heartburn caused by coffee in certain susceptible persons [6].
  • Cimetidine, but not placebo, reduced acid secretion and heartburn in response to coffee, suggesting that acid was required for the development of symptoms [6].
  • RESULTS: Four patients were dropped from the study (sulindac group) due to urosepsis (1 patient), heartburn (2 patients), and anemia (1 patient) [7].
  • Complete relief of nighttime heartburn was noted by 79.5% of patients in the 20-mg omeprazole group, 85.1% in the 40-mg omeprazole group, and 34.9% in the placebo group (P less than or equal to 0.05) [8].
  • Metoclopramide significantly suppressed the subjective signs of nausea (7 of 8 cases) and heartburn (all cases) [9].

Chemical compound and disease context of Heartburn

  • Clinical effectiveness of antacids and bethanechol in therapy of heartburn is supported by controlled treatment trials [10].
  • Epigastric pain and/or heartburn were significantly less frequent in patients receiving omeprazole (P =.00124) or ranitidine (P =.038) than in those receiving placebo [11].
  • CONCLUSION: Lansoprazole, at a daily dose of 15 mg or 30 mg, is significantly better than placebo in reducing symptoms of persistent or recurrent upper abdominal discomfort accompanied by at least some symptoms of heartburn [12].
  • Compared with baseline, significant increases in time to heartburn was found with famotidine at weeks 4 (383 (102), p < 0.01) and 5 (344 (92), p < 0.01) but not week 8 (336 (90) seconds) [13].
  • A double-blind, placebo-controlled study of the effectiveness and safety of nizatidine in the prevention of postprandial heartburn [14].

Biological context of Heartburn

  • However, 2 patients with normal emptying studies had symptomatic heartburn, and 2 patients with delay of both solid and liquid gastric emptying gave no history of gastroesophageal reflux [15].
  • In an effort to piece together the complex puzzle, investigators from all disciplines have gathered their patients with wheezing and heartburn and studied the epidemiology, the possible cause or effect mechanisms and the therapeutic response to GER treatment [16].
  • Significant adverse effects of aspirin were noted with respect to the side effects of stomach pain, heartburn and vomiting, elevation of systolic blood pressure to greater than 160 mm Hg, and elevation of serum urea nitrogen and serum uric acid levels to the abnormal range [17].

Anatomical context of Heartburn

  • Future studies in patients with symptomatic GER disease (GERD) should be able to determine whether typical symptoms such as heartburn, as well as atypical symptoms such as chest pain, are related to the GER-related distention of the esophagus [18].
  • The purpose of this study was to compare the safety profile and efficacy of famotidine oral dosing regimens, 40 mg nocte and 20 mg b.d. with placebo in the relief of symptoms in patients suffering from frequent heartburn found to have endoscopically normal oesophageal mucosa or mild non-erosive oesophagitis [19].
  • Risedronate-treated patients with active heartburn, esophagitis, other esophageal disorders, or peptic ulcer disease at study entry did not experience worsening of their underlying conditions or an increased frequency of upper GI tract adverse events overall [20].
  • Both ranitidine and omeprazole significantly reduced gastric acid output (P less than 0.001) and gastric volume output (P less than 0.001) compared to a basal evaluation and resulted in complete disappearance of pyrosis [21].
  • Since diurnal and episodic release of steroid and peptide hormones occur, it is postulated that heartburn and other digestive dysfunction during pregnancy are associated with elevated steroid and peptide (beta-endorphin, NPY) hormone interaction with innate biological rhythms controlling the gastrointestinal tract [22].

Gene context of Heartburn

  • Heartburn correlated positively with the mean somatostatin level [23].
  • Of 68 patients with CF greater than or equal to 5 years of age, 20.6% experienced regurgitation and 26.5% had heartburn [24].
  • Increased TRPV1 expression in the inflamed oesophagus may mediate the heartburn in oesophagitis, and TRPV1 blockers may provide novel treatment [25].
  • METHODS: A total of 247 patients with dyspeptic symptoms (166 women, mean age 44 (SEM 1) year), with a negative upper gastrointestinal endoscopy and without dominant symptoms of heartburn participated in the study [26].
  • CONCLUSION: Proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or "step-up" or "step-down" therapy [27].

Analytical, diagnostic and therapeutic context of Heartburn


  1. Coprescribing and codispensing of cisapride and contraindicated drugs. Jones, J.K., Fife, D., Curkendall, S., Goehring, E., Guo, J.J., Shannon, M. JAMA (2001) [Pubmed]
  2. Gastroesophageal reflux disease in the Zollinger-Ellison syndrome. Richter, J.E., Pandol, S.J., Castell, D.O., McCarthy, D.M. Ann. Intern. Med. (1981) [Pubmed]
  3. Long-term comparison of antireflux surgery versus conservative therapy for reflux esophagitis. Isolauri, J., Luostarinen, M., Viljakka, M., Isolauri, E., Keyriläinen, O., Karvonen, A.L. Ann. Surg. (1997) [Pubmed]
  4. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy. A case-control study. Chan, A.K., Duh, Q.Y., Katz, M.H., Siperstein, A.E., Clark, O.H. Ann. Surg. (1995) [Pubmed]
  5. Sucralfate used as adjunctive therapy in patients with severe erosive peptic esophagitis resulting from gastroesophageal reflux. Herrera, J.L., Shay, S.S., McCabe, M., Peura, D.A., Johnson, L.F. Am. J. Gastroenterol. (1990) [Pubmed]
  6. Pathogenesis of coffee-induced gastrointestinal symptoms. Cohen, S. N. Engl. J. Med. (1980) [Pubmed]
  7. Effect of sulindac on sporadic colonic polyps. Ladenheim, J., Garcia, G., Titzer, D., Herzenberg, H., Lavori, P., Edson, R., Omary, M.B. Gastroenterology (1995) [Pubmed]
  8. Two doses of omeprazole versus placebo in symptomatic erosive esophagitis: the U.S. Multicenter Study. Sontag, S.J., Hirschowitz, B.I., Holt, S., Robinson, M.G., Behar, J., Berenson, M.M., McCullough, A., Ippoliti, A.F., Richter, J.E., Ahtaridis, G. Gastroenterology (1992) [Pubmed]
  9. Successful administration of metoclopramide for the treatment of nausea in patients with advanced liver disease. A double-blind controlled trial. Uribe, M., Ballesteros, A., Strauss, R., Rosales, J., Garza, J., Villalobos, A., Briones, A., Garcia Ramos, G. Gastroenterology (1985) [Pubmed]
  10. The lower esophageal sphincter. Physiologic and clinical aspects. Castell, D.O. Ann. Intern. Med. (1975) [Pubmed]
  11. Randomized trial of omeprazole or ranitidine versus placebo in the prevention of chemotherapy-induced gastroduodenal injury. Sartori, S., Trevisani, L., Nielsen, I., Tassinari, D., Panzini, I., Abbasciano, V. J. Clin. Oncol. (2000) [Pubmed]
  12. Lansoprazole in the treatment of functional dyspepsia: two double-blind, randomized, placebo-controlled trials. Peura, D.A., Kovacs, T.O., Metz, D.C., Siepman, N., Pilmer, B.L., Talley, N.J. Am. J. Med. (2004) [Pubmed]
  13. Effect of famotidine on oesophageal sensitivity in gastro-oesophageal reflux disease. Marrero, J.M., de Caestecker, J.S., Maxwell, J.D. Gut (1994) [Pubmed]
  14. A double-blind, placebo-controlled study of the effectiveness and safety of nizatidine in the prevention of postprandial heartburn. Spiegel, J.E., Thoden, W.R., Pappas, K., Fratarcangelo, P., Furey, S.A. Arch. Intern. Med. (1997) [Pubmed]
  15. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis. Maddern, G.J., Horowitz, M., Jamieson, G.G., Chatterton, B.E., Collins, P.J., Roberts-Thomson, P. Gastroenterology (1984) [Pubmed]
  16. Gastroesophageal reflux and asthma. Sontag, S.J. Am. J. Med. (1997) [Pubmed]
  17. Aspirin in coronary heart disease. Comparison of six clinical trials. Canner, P.L. Isr. J. Med. Sci. (1983) [Pubmed]
  18. Measuring esophageal distention by high-frequency intraluminal ultrasound probe. Mittal, R.K. Am. J. Med. (2003) [Pubmed]
  19. Famotidine (20 mg) b.d. relieves gastrooesophageal reflux symptoms in patients without erosive oesophagitis. Famotidine/GERD Investigation Group. Robinsen, M., Decktor, D.L., Stone, R.C., Pevelery, M., Barden, P., Moyer, R., Holt, S., Root, J., Hufnagel, K., Humphries, T.J. Aliment. Pharmacol. Ther. (1991) [Pubmed]
  20. Upper gastrointestinal tract safety of risedronate: a pooled analysis of 9 clinical trials. Taggart, H., Bolognese, M.A., Lindsay, R., Ettinger, M.P., Mulder, H., Josse, R.G., Roberts, A., Zippel, H., Adami, S., Ernst, T.F., Stevens, K.P. Mayo Clin. Proc. (2002) [Pubmed]
  21. Comparison of omeprazole and ranitidine in treatment of refractory gastroesophageal reflux disease in patients with gastric acid hypersecretion. Collen, M.J., Strong, R.M. Dig. Dis. Sci. (1992) [Pubmed]
  22. Pickles, peptide hormones and pregnancy: a hypothesis. Hill, P. Med. Hypotheses (1990) [Pubmed]
  23. Gastrin, cholecystokinin, and somatostatin in a laboratory experiment of patients with functional dyspepsia. Jonsson, B.H., Uvnäs-Moberg, K., Theorell, T., Gotthard, R. Psychosomatic medicine. (1998) [Pubmed]
  24. Gastroesophageal reflux in patients with cystic fibrosis. Scott, R.B., O'Loughlin, E.V., Gall, D.G. J. Pediatr. (1985) [Pubmed]
  25. Increased capsaicin receptor TRPV1 nerve fibres in the inflamed human oesophagus. Matthews, P.J., Aziz, Q., Facer, P., Davis, J.B., Thompson, D.G., Anand, P. European journal of gastroenterology & hepatology. (2004) [Pubmed]
  26. Prevalence of acid reflux in functional dyspepsia and its association with symptom profile. Tack, J., Caenepeel, P., Arts, J., Lee, K.J., Sifrim, D., Janssens, J. Gut (2005) [Pubmed]
  27. Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. Howden, C.W., Henning, J.M., Huang, B., Lukasik, N., Freston, J.W. Am. J. Gastroenterol. (2001) [Pubmed]
  28. Effect of topical oesophageal acidification on human salivary and oesophageal alkali secretion. Brown, C.M., Snowdon, C.F., Slee, B., Sandle, L.N., Rees, W.D. Gut (1995) [Pubmed]
  29. Do endoscopic findings influence response to H2 antagonist therapy for gastroesophageal reflux disease? Robinson, M.G., Orr, W.C., McCallum, R., Nardi, R. Am. J. Gastroenterol. (1987) [Pubmed]
  30. Comparing lansoprazole and omeprazole in onset of heartburn relief: results of a randomized, controlled trial in erosive esophagitis patients. Richter, J.E., Kahrilas, P.J., Sontag, S.J., Kovacs, T.O., Huang, B., Pencyla, J.L. Am. J. Gastroenterol. (2001) [Pubmed]
  31. Omeprazole is more effective than cimetidine for the relief of all grades of gastro-oesophageal reflux disease-associated heartburn, irrespective of the presence or absence of endoscopic oesophagitis. Bate, C.M., Green, J.R., Axon, A.T., Murray, F.E., Tildesley, G., Emmas, C.E., Taylor, M.D. Aliment. Pharmacol. Ther. (1997) [Pubmed]
  32. Gastric and duodenal ulcers during pregnancy. Cappell, M.S., Garcia, A. Gastroenterol. Clin. North Am. (1998) [Pubmed]
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