{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T15:29:07Z","timestamp":1786548547558,"version":"build-2736575974"},"reference-count":99,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T00:00:00Z","timestamp":1539561600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Am J Gastroenterol"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>The Montreal definition of gastroesophageal reflux disease (GERD) provided a rationale for acid suppression medication without investigation, thus enhancing the management of the substantial symptom burden in these patients. Increased proton-pump inhibitor use has also highlighted their limitations, with one third of \u201ctypical\u201d symptoms known to be refractory. Most refractory symptoms are ascribed to reflux hypersensitivity (RH) and functional heartburn (FH). RH may be caused by impaired esophageal mucosal barrier function and sensitization of peripheral esophageal receptors. Central sensitization may also contribute to the perception of non-pathologic reflux in RH, and the perception of physiological stimuli in FH. Importantly, mechanisms underlying GERD, RH, and FH are (in theory) not mutually exclusive, further complicating patient management. Methods used to distinguish GERD from RH and FH are impractical for use in epidemiological studies and pragmatic care and may have limited diagnostic accuracy. This is impeding accurate prevalence estimates and risk factor determination and the identification of new therapies. Direct assessment of mucosal barrier function by measuring impedance is a promising candidate for improved diagnosis. Ultimately though the concept of GERD as a composite, symptom-based entity needs re-evaluation, so that new understandings of upper GI symptoms can direct more precise management.<\/jats:p>","DOI":"10.1038\/s41395-018-0287-1","type":"journal-article","created":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T08:17:25Z","timestamp":1539591445000},"page":"414-421","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":50,"title":["Revisiting Montreal: New Insights into Symptoms and Their Causes, and Implications for the Future of GERD"],"prefix":"10.14309","volume":"114","author":[{"given":"A. Pali S.","family":"Hungin","sequence":"first","affiliation":[{"name":"The Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Molloy-Bland","sequence":"additional","affiliation":[{"name":"Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Scarpignato","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology & Digestive Pathophysiology Unit, Department of Clinical & Experimental Medicine, University of Parma, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,10,15]]},"reference":[{"key":"R1-20250611","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1111\/j.1572-0241.2006.00630.x","article-title":"The Montreal definition and classification of gastroesophageal 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