Burning behind the sternum is usually immediately associated with gastroesophageal reflux. However, not always when this sensation exists there is an excessive amount of acid rising from the stomach. In some patients, tests show exposure to acid within the normal range and yet the discomfort persists. This can happen in the case of functional pyrosis.
Identifying correctly The origin of the symptoms It is important, especially when the burning occurs recurrently and the usual treatments to reduce acidity do not improve the situation.
The functional pyrosis It is a disorder in which a burning or stinging sensation in the retrosternal area similar to that of a burn appears. Gastro-oesophageal reflux, But without evidence that acid reflux is responsible for the symptoms.
The criteria of Rome IV differentiate it from other esophageal disorders because there is exposure to acid within normal parameters and there is no clear relationship between reflux episodes and the time when the burning sensation appears.
That is, the patient actually feels the symptom, but its origin may lie in another place. increased sensitivity of the esophagus and in the way the nervous system processes certain signals from the digestive system.
When a person experiences heartburn frequently, it is common to think that there is too much acid production. This can lead to using medications intended to reduce acid production for long periods without achieving the expected improvement.
However, different problems can produce symptoms that appear very similar:
This differentiation is especially relevant because the appropriate treatment may be different in each situation.
In the functional pyrosis, One of the mechanisms involved may be an increased sensitivity of the nerve endings of the esophagus.
This means that stimuli that would normally go unnoticed by the body can be interpreted by the body as annoying or painful. There does not need to be a visible injury to experience symptoms.
There is also an interaction between the digestive system and the nervous system, known as gut-brain axis. The mechanisms by which the brain receives, interprets, and modulates signals from the esophagus can influence the intensity with which burning sensation is perceived.
Therefore, the functional pyrosis It should not be interpreted simply as a problem of “having more or less acid”, but as a more complex alteration in the perception of esophageal signals.
One of the scenarios that may make it necessary to study other causes appears when a person presents frequent retrosternal burning sensation and does not receive an adequate response to properly administered antisecretory treatments.
For this reason, it is recommended to consider this diagnosis in the presence of persistent symptoms despite optimal antisecretory therapy and to perform a specific study before confirming it.
Some situations that may justify a specialized valuation are:
These signs alone do not allow a functional gastritis to be diagnosed. It is necessary to study each case to rule out other possible causes.
The diagnosis of functional pyrosis It requires demonstrating that gastroesophageal reflux or other diseases of the esophagus do not explain the discomfort. The choice of tests depends on the symptoms, the history, and the results obtained previously. Not all patients need to undergo the same study.
The Gastroscopy It allows the esophagus to be directly observed and detected for inflammation, lesions, or other structural abnormalities. Depending on the case, biopsies can also be obtained to rule out certain diseases of the esophageal mucosa.
The tests of pHmetry or pH-impedancemetry They allow the exposure of the esophagus to acid and reflux episodes to be analyzed over a prolonged period.
In addition to measuring how much reflux occurs, they help verify whether there is a temporal relationship between the recorded episodes and the symptoms reported by the patient.
In certain situations it may be necessary to perform an High-resolution oesophageal manometry, This test allows the functioning and movements of the esophagus to be studied and important motor disorders to be ruled out.
The combination of these tests allows for a better differentiation between ERGE, reflux hypersensitivity, and functional heartburn.
Treatment must be adapted to the characteristics of each patient and, above all, to the mechanism responsible for their symptoms.
When a confirmation is made functional pyrosis Without associated reflux disease, continuing to increase the treatment aimed at reducing acid may not provide any benefit, since the problem is not due to excessive acid exposure.
Depending on the case, the specialist can evaluate strategies aimed at Modulating esophageal sensitivity, Certain neuromodulatory treatments at specific doses or interventions aimed at improving the regulation of the gut-brain axis.
The fundamental thing is avoid treating only the symptom without having previously determined what its origin may be.
Having heartburn does not necessarily mean suffering from an excess of acid. functional pyrosis It demonstrates that very similar symptoms can have completely different mechanisms and that, when the discomfort persists, it may be necessary to go beyond the usual treatments for reflux.
Performing the appropriate tests allows us to know what is really happening in the esophagus, rule out other diseases, and guide treatment more accurately.
If you have frequent heartburn and the usual treatments are not helping to control your symptoms, you may need to consider surgery. GASTEIZ We can study your case individually. Request a consultation with our team Specialists in the Digestive System to assess the source of your discomfort and determine which tests or treatments may be most appropriate for you.
