Old heartburn, multiple definitions

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Human beings (and perhaps animals too) have had heartburn since times immemorial. With the advent of "internet medicine", TV advertising, and advancement in medical knowledge, the distinctions between the various symptoms (heartburn, chest pain etc), the disease (gastroesophageal reflux disease or GERD) and complications frequently gets blurred.

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Vakil and colleagues published (American Journal of Gastroenterology August 2006) the recommendations from the International Consensus group comprising of 44 experts from 18 countries. These were based on thorough literature search and appropriate grading of evidence followed by voting processes among the experts. Consensus was defined as agreement among at least two-thirds of participants.

1. GERD is defined as condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The symptoms are considered troublesome when they adversely affect the person's well being.
2. Reflux symptoms that are not troublesome or cause complications do not qualify as GERD.
3. The patient should determine whether the symptoms are troublesome. Having said that, generally mild symptoms 2 or more per week or moderate to severe symptoms once a week are usually considered troublesome by patients.'
4. Heartburn may have non-reflux related causes.
5. Chest pain indistinguishable from ischemic heart disease may occur due to GERD.
6. The use of the term "Barrett's esophagus" is variably interpreted and lacks clarity. The notion that intestinal metaplasia is a prerequisite for diagnosis is not uniformly accepted.

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