Gastroenterology & Hepatology

December 2017 - Volume Volume 13, Issue Issue 12

Letter From the Editor: Functional Heartburn

Gary R. Lichtenstein, MD, AGAF, FACP, FACG


What is functional heartburn, and how does it differ from other esophageal conditions, such as reflux hypersensitivity and nonerosive reflux disease? In one of our feature articles in this month’s issue of Gastroenterology & Hepatology, Dr Takahisa Yamasaki, Ms Jessica O’Neil, and Dr Ronnie Fass provide an update on functional heartburn by examining the definition of this common condition and tracing its evolution over the past several Rome criteria. As the authors note, according to Rome IV criteria, functional heartburn is currently defined as typical symptoms of heartburn along with normal upper endoscopy findings and biopsies, normal esophageal pH testing, and a negative association between symptoms and reflux events. In their article, the authors also discuss the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of functional heartburn.

Our other feature article this month focuses on vaccination and health maintenance issues in patients with inflammatory bowel disease (IBD). Dr Jason Reich, Dr Sharmeel K. Wasan, and Dr Francis A. Farraye examine the diminished immune response of patients with IBD to vaccination as well as the low vaccination rates currently seen in this patient population. The authors also review all of the relevant vaccines for patients with IBD, including vaccinations for influenza; pneumococcal pneumonia; hepatitis A and B viruses; human papilloma virus; tetanus, diphtheria, and pertussis; measles, mumps, and rubella; and herpes zoster. In addition, the authors cover important health maintenance issues that may be encountered by patients with IBD, including heart disease, smoking, osteoporosis, cervical cancer, skin cancer, and mental health issues.

Our IBD coverage continues in the Advances in IBD column, which features the last of our 3-part series on biosimilars in IBD. Dr Brian Feagan examines the main benefits and concerns of this new therapeutic option for patients with IBD. In addition, he discusses the next steps in this area, particularly the need for high-quality studies on nonmedical switching and the risk of immunogenicity.

In addition, Dr D. Nageshwar Reddy explores the use of narrow-band imaging (NBI) to establish a diagnosis of gastroesophageal reflux disease (GERD) in our Advances in GERD column. He discusses the most common indications for NBI, its associated benefits and limitations, and its sensitivity and specificity in this setting, along with related issues.

Our Advances in Hepatology column, authored by Dr Monica T. Garcia-Buitrago, focuses on hepatocellular adenomas, the third most common benign liver tumors, and the importance of beta-catenin staining. Among other issues, she discusses the various types of hepatocellular adenomas, which of these tumors are most likely to undergo malignant transformation (and how often), and the benefits and limitations of using beta-catenin immunostains in this setting.

In our Advances in Endoscopy column, Dr Barham K. Abu Dayyeh provides an overview of intragastric balloons for the management of obesity, including the various options currently available; their advantages, disadvantages, adverse events, and short- and long-term efficacies; and balloons that are currently awaiting approval from the US Food and Drug Administration.

The updated guidelines for hepatocellular carcinoma (HCC) from the American Association for the Study of Liver Diseases are explored in our HCC in Focus column. Among other issues, Dr Julie K. Heimbach discusses how and why the updated guidelines were developed; several important new or updated recommendations involving the surveillance, diagnosis, and treatment of HCC; and long-term questions for future research.

Finally, this month’s issue includes 2 Clinical Update columns highlighting several interesting abstracts from recent conferences. One column focuses on abstracts on Clostridium difficile infection from the World Congress of Gastroenterology at ACG 2017, while the other column features abstracts on the treatment of functional dyspepsia from Digestive Disease Week 2017.

May this issue provide you with helpful information that you can put to good use in your clinical practice.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc