Behavioral Therapy for Functional Heartburn: Recommendation Statements

Livia Guadagnoli, Rena Yadlapati, John Pandolfino, Alyse Bedell, Anjali U. Pandit, Kerry B. Dunbar, Ronnie Fass, Richard Gevirtz, C. Prakash Gyawali, Stephen E. Lupe, Megan Petrik, Megan E. Riehl, Jessica Salwen-Deremer, Madison Simons, Kathryn N. Tomasino, Tiffany Taft

Research output: Contribution to journalArticlepeer-review


Background & Aims: Brain-gut behavior therapies (BGBT) are increasingly recognized as effective therapeutic interventions for functional heartburn. However, recommendations regarding candidacy for treatment, initial treatment selection, and navigating treatment non-response have not been established for functional heartburn specifically. The aim of this study was to establish expert-based recommendations for behavioral treatment in patients with functional heartburn. Methods: The validated RAND/University of California, Los Angeles Appropriateness Method was applied to develop recommendations. A 15-member panel composed of 10 gastrointestinal psychologists and 5 esophageal specialists ranked the appropriateness of a series of statements on a 9-point interval scale over 2 ranking periods. Statements were within the following domains: pre-therapy evaluation, candidacy criteria for BGBT, selection of initial BGBT, role of additional therapy for initial non-response to BGBT, and role of pharmacologic neuromodulation. The primary outcome was appropriateness of each intervention based on the recommendation statements. Results: Recommendations for psychosocial assessment (eg, hypervigilance, symptom-specific anxiety, health-related quality of life), candidacy criteria (eg, motivated for BGBT, acknowledges the role of stress in symptoms), and treatment were established. Gut-directed hypnotherapy or cognitive behavioral therapy were considered appropriate BGBT for functional heartburn. Neuromodulation and/or additional BGBT were considered appropriate in the context of non-response. Conclusions: Gut-directed hypnotherapy and/or cognitive behavioral therapy are recommended as appropriate behavioral interventions for heartburn symptoms, depending on clinical indication, specific gut-brain targets, and preferred treatment modality (pharmacologic vs non-pharmacologic). Pre-therapy evaluation of psychosocial processes and candidacy for BGBT are important to determine eligibility for referral to psychogastroenterology services.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
StateAccepted/In press - 2024


  • Behavioral Medicine
  • Esophageal Disorder
  • Health-Related Quality of Life
  • Heartburn
  • Psychogastroenterology


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