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MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
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  3. Reflux Hypersensitivity
Functional GI

Reflux Hypersensitivity

Rome IV — normal acid exposure, positive symptom association

Rome IV applies the same duration rule to every functional oesophageal disorder. Onset within the last six months does not meet criteria however typical the symptoms are.

Biopsies are required; a normal-looking oesophagus does not exclude EoE.

Both halves are required. Physiological acid exposure plus a positive symptom-reflux association — this is the single criterion that separates reflux hypersensitivity from functional heartburn.

Normal acid exposure but symptoms that track reflux events — a normal amount of reflux perceived abnormally. Response to acid suppression does not exclude the diagnosis.

When to use
Use it when a patient with persistent heartburn or chest pain has had reflux monitoring showing normal acid exposure, and the symptom association analysis was positive. It is the diagnosis that sits between reflux disease and functional heartburn, and it exists precisely for the patients those two labels handled badly — people whose acid exposure is normal but whose symptoms clearly follow reflux events, and who often get partial benefit from acid suppression that a diagnosis of functional heartburn would not predict. It cannot be applied without symptom association analysis, which means it cannot be applied to a monitoring study during which the patient recorded no symptoms.
Why use it
Because it changes what you do with the acid suppression. Rome III grouped these patients with functional heartburn, which carries an implicit instruction to stop reflux-directed treatment — but a patient whose symptoms reliably follow reflux events has a mechanism that acid suppression and alginates can act on, even though the total acid burden is normal. Recognising reflux hypersensitivity means continuing what partially works while adding a neuromodulator for the hypersensitivity component, rather than withdrawing the first in favour of the second. It also flags a group in whom anti-reflux surgery is occasionally considered and where the evidence is genuinely uncertain, which is a more useful position than the blanket 'no' that applies in functional heartburn.
Formula, evidence and interpretation

About the Rome IV Criteria for Reflux Hypersensitivity

A normal amount of reflux, perceived abnormally — that is the whole concept. Rome IV requires retrosternal symptoms of heartburn or chest pain at least twice a week over three months with onset at least six months ago, a normal endoscopy with no eosinophilic oesophagitis, no major oesophageal motor disorder, and the defining finding: physiological acid exposure on pH or pH-impedance monitoring together with evidence that reflux events trigger the symptoms. Both halves of that last criterion are required. Unlike functional heartburn, a response to acid suppression does not exclude the diagnosis.

On this page

  • Formula
  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Formula

Reflux hypersensitivity = ALL of: retrosternal symptoms including heartburn or chest pain AND normal endoscopy and no evidence of eosinophilic oesophagitis AND no major oesophageal motor disorder AND evidence of symptoms triggered by reflux despite normal acid exposure AND criteria fulfilled for the last 3 months, onset >= 6 months ago, at least twice a week
Normal acid exposure
Total acid exposure time within normal limits on reflux monitoring. Abnormal exposure makes this reflux disease rather than hypersensitivity.
Positive symptom-reflux association
Symptom index or symptom association probability linking symptoms to physiological reflux events. This is the whole basis for splitting the category from functional heartburn.
At least twice a week
Shared with functional heartburn, and higher than the once-a-week threshold used for chest pain, globus and dysphagia.
  • Normal acid exposure WITH a positive symptom-reflux association is the whole definition — abnormal acid exposure makes it reflux disease instead.
  • Rome IV split this from functional heartburn because a positive symptom-reflux association predicts partial response to reflux-directed treatment.

Interpreting the result

A patient meeting these criteria has a normal reflux burden and an abnormal response to it. Practically that means acid suppression is worth continuing if it helps — this is the key divergence from functional heartburn, where non-response is a diagnostic requirement and continued treatment is futile by definition. Alginates and other reflux-directed measures are similarly reasonable. On top of that, a neuromodulator addresses the hypersensitivity itself, and the combination is more effective than either alone in most patients. Where the criteria are not met, the gap is usually the symptom association analysis: a monitoring study reported only as 'normal acid exposure' has answered half the question, and without the association data the patient cannot be distinguished from functional heartburn. One honest caveat to carry: whether reflux hypersensitivity belongs among the functional disorders at all is contested, since a demonstrable symptom-reflux association arguably makes it part of the reflux spectrum rather than a disorder of gut-brain interaction. The label is useful because it predicts treatment response, not because the taxonomy is settled.

ScoreBandWhat it meansAction
All criteria metReflux hypersensitivityPhysiological acid exposure with symptoms that track reflux events — a normal stimulus perceived abnormallyContinue acid suppression if it helps, and add a neuromodulator for the hypersensitivity component
Any criterion unmetCriteria not metMost often because symptom association analysis was not performed or was uninterpretableRepeat monitoring with symptom recording. Normal acid exposure with a negative association is functional heartburn instead

What the Reflux Hypersensitivity needs (5 inputs)

Timing and frequency
Criteria fulfilled for the last three months, onset at least six months before diagnosis, occurring at least twice a week — the same threshold as functional heartburn and stricter than the other three oesophageal disorders.
Retrosternal symptoms — heartburn or chest pain
Broader than functional heartburn, which requires burning specifically. Reflux hypersensitivity accommodates chest pain as the presenting symptom as well.
Normal endoscopy and no eosinophilic oesophagitis
Biopsies are required. Eosinophilic oesophagitis can produce reflux-like symptoms with a normal-looking oesophagus, and it is treated entirely differently.
No major oesophageal motor disorder
Achalasia, EGJ outflow obstruction, distal oesophageal spasm, jackhammer oesophagus or absent contractility on high-resolution manometry.
Normal acid exposure WITH evidence that reflux events trigger the symptoms
The single criterion that defines the disorder, and it has two halves that must both hold. Physiological acid exposure rules out reflux disease; the positive symptom-reflux association rules out functional heartburn. Assessed with symptom index and symptom association probability on pH or pH-impedance monitoring.

What it returns

Criteria met or not met
Conjunctive — every criterion including the timing rule must hold.
Which criteria remain outstanding
Named explicitly. In practice the missing item is almost always the symptom association analysis rather than a clinical feature.

How it is calculated

The disorder was carved out of Rome III's functional heartburn category on a mechanistic argument. Reflux monitoring produces two independent results: how much acid the oesophagus is exposed to, and whether the patient's symptoms coincide with reflux events. Rome III treated normal acid exposure as the decisive finding and grouped everyone who had it together. Rome IV recognised that the second result carries separate information — a patient whose symptoms reliably follow reflux episodes is reacting to a real stimulus with an exaggerated response, while a patient with no such association is generating symptoms independently of reflux altogether. Those are different physiologies with different treatment implications, and the committee named the first reflux hypersensitivity. Everything else in the criteria is exclusion, and the exclusions match the other functional oesophageal disorders because the same conditions have to be ruled out.

Facts & figures

What the two halves of the defining criterion each exclude
FindingWhat it rules outLeaves
Acid exposure normalGastro-oesophageal reflux diseaseReflux hypersensitivity or functional heartburn
Symptom-reflux association positiveFunctional heartburnReflux hypersensitivity
Symptom-reflux association negativeReflux hypersensitivityFunctional heartburn

A monitoring report giving acid exposure but not symptom association has completed only the first row. That is the commonest reason this diagnosis cannot be made when it should be.

Evidence

Derivation — Rome Foundation, oesophageal disorders committee

2016

Consensus criteria from the Rome IV oesophageal disorders committee, creating reflux hypersensitivity as a distinct disorder from what Rome III had classified as functional heartburn.

Consensus-derived with no discrimination statistics. The justification for the split is that the presence of a symptom-reflux association predicts partial response to reflux-directed treatment, which the undivided category could not.

Reflux diagnostic framework — Lyon Consensus 2.0

2024

International consensus defining conclusive evidence for and against gastro-oesophageal reflux disease using endoscopy, reflux monitoring and adjunctive metrics.

Sets the acid exposure thresholds that determine whether exposure is physiological, and addresses how symptom association metrics should be interpreted alongside them.

Guideline adoption — ACG 2022

2022

American College of Gastroenterology guideline on gastro-oesophageal reflux disease.

Routes refractory reflux symptoms through monitoring with symptom association analysis, which is what separates reflux hypersensitivity from functional heartburn and from persistent reflux disease.

How it compares

Reflux Hypersensitivity vs Functional heartburn

Identical except for the symptom-reflux association, and that single difference reverses the advice on acid suppression.

Both require normal acid exposure, normal endoscopy with biopsies and no major motor disorder. In reflux hypersensitivity the symptoms track reflux events, so acid suppression may work partially and continuing it is appropriate. In functional heartburn there is no association and non-response to acid suppression is itself a diagnostic criterion, so continued treatment is futile. Getting this the wrong way round means either withdrawing a drug that was helping or persisting with one that cannot. The separation is made on symptom association analysis and nothing else — not on symptom severity, duration or character.

Open the Functional heartburn calculator →

Reflux Hypersensitivity vs Gastro-oesophageal reflux disease

GORD has abnormal acid exposure; reflux hypersensitivity has a normal amount of reflux that the oesophagus over-reports.

The Lyon Consensus defines where physiological acid exposure ends and conclusive reflux disease begins, and reflux hypersensitivity sits below that line by definition. The overlap in treatment is real — both may respond to acid suppression — which is why the boundary matters more for what comes next than for what is prescribed first. In established reflux disease, escalation and eventually surgery are rational. In reflux hypersensitivity, escalating acid suppression usually stops helping at some point because the acid burden was never the problem, and the addition that changes things is a neuromodulator.

Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361-371.

Reflux Hypersensitivity vs Functional chest pain

Reflux hypersensitivity can present as chest pain, so the two overlap in symptom — the separator is again the reflux monitoring.

Functional chest pain requires the absence of associated oesophageal symptoms and no evidence that reflux is responsible. Reflux hypersensitivity permits chest pain as the presenting symptom but requires a demonstrated association with reflux events. A patient with non-cardiac chest pain and a positive symptom-reflux association therefore has reflux hypersensitivity rather than functional chest pain, and the practical difference is that reflux-directed treatment is worth trying in the first and not in the second. Both are treated with neuromodulators once that is settled.

Open the Functional chest pain calculator →

Pearls & pitfalls

  • The defining criterion has two halves. Normal acid exposure alone is not reflux hypersensitivity — without a positive symptom-reflux association it is functional heartburn.
  • A monitoring study with no recorded symptoms cannot establish an association, so the diagnosis cannot be made from it however normal the acid exposure looks.
  • Response to acid suppression does NOT exclude this diagnosis. That is the opposite of functional heartburn, where non-response is a criterion, and confusing the two leads to acid suppression being withdrawn from patients it was helping.
  • The symptom criterion is broader than functional heartburn's — chest pain qualifies here, not only burning.
  • Symptom index and symptom association probability measure different things and can disagree. Where they conflict, the study should be interpreted rather than reduced to a single positive-or-negative verdict.
  • Biopsies are still required. Eosinophilic oesophagitis is excluded by histology, not by appearance.
  • Twice a week is the frequency threshold, shared with functional heartburn and stricter than globus, functional dysphagia and functional chest pain.
  • Whether this belongs among the functional disorders is genuinely debated. Presenting it to a patient as definitively 'not reflux' overstates a taxonomy that is not settled.

Critical actions

  • Ensure the reflux monitoring study includes symptom association analysis and that the patient was instructed to record symptoms — without that, the study cannot answer the question.
  • Perform endoscopy with oesophageal biopsies to exclude eosinophilic oesophagitis.
  • Obtain high-resolution manometry to exclude a major motor disorder.
  • Continue acid suppression where it is producing partial benefit rather than stopping it on the strength of the functional label.
  • Add a neuromodulator at low dose for the hypersensitivity component, explained in terms of nerve sensitivity rather than mood.
  • Consider oesophageal-directed hypnotherapy or cognitive behavioural therapy alongside.
  • Be cautious about anti-reflux surgery — the evidence in this group is uncertain, and it is not the clear contraindication that functional heartburn represents.

Why this score exists

The committee was candid that this was the most contested of the five oesophageal disorders, and the objection is easy to state: if reflux events demonstrably cause the symptoms, is this a functional disorder at all, or the mild end of reflux disease? The argument for placing it among the functional disorders is that the abnormality lies in perception rather than in the refluxate — the stimulus is physiological and the response is not, which is the same logic that classifies visceral hypersensitivity elsewhere in the gut. The argument against is that the treatment overlaps substantially with reflux disease. The committee's practical position was that the label earns its place by predicting something useful, namely that acid suppression will help partially rather than not at all, and that has held up better than the taxonomic question has been settled.

About the creator

  • Qasim Aziz

    First author, Rome IV oesophageal disorders committee

    Chaired the committee that defined reflux hypersensitivity as a distinct Rome IV disorder.

  • Ronnie Fass

    Co-author; hypersensitive oesophagus literature

    Contributed much of the work on the hypersensitive oesophagus that reflux hypersensitivity renamed and formalised.

  • Frank Zerbib

    Co-author; oesophageal physiology and impedance monitoring

    Co-authored the Rome IV chapter and much of the underlying impedance-monitoring methodology the criteria depend on.

Limitations

  • Entirely dependent on symptom association analysis, whose thresholds — symptom index and symptom association probability — are themselves debated and can disagree with each other.
  • A study during which the patient records few or no symptoms is uninterpretable, and repeat monitoring is often impractical.
  • Acid exposure and symptom association both vary day to day, so a single study can misclassify.
  • Its classification as a functional disorder rather than part of the reflux spectrum is genuinely contested, and the boundary with mild reflux disease is not sharp.
  • Requires oesophageal physiology testing, so it is unavailable where reflux monitoring is not offered.
  • Consensus-based, and the symptom-reflux association indices that define it have known reproducibility problems between studies and between days.
  • Evidence for specific treatments in this disorder, as distinct from functional heartburn, remains thin because it is a recent category.
  • Says nothing about severity or about coexisting psychological comorbidity, which often needs addressing separately.

If you are the patient

Reflux hypersensitivity means your oesophagus is producing a normal amount of reflux, but it is far more sensitive to it than most people's. Tests show the total amount of acid coming up is within the normal range — yet when reflux does happen, you feel it clearly as heartburn or chest pain, and the recording confirms your symptoms line up with those moments. So this is not 'nothing wrong', and it is not simply reflux disease either: it sits between the two. The practical consequence is helpful. Because reflux really is triggering your symptoms, acid-reducing treatment often gives partial relief, and if it is helping there is usually no reason to stop it. But because the underlying problem is sensitivity rather than excess acid, increasing the dose indefinitely tends to stop making a difference. What often helps most is adding a second medicine that reduces how strongly the nerves in your gullet report sensation. These are frequently drugs also used as antidepressants, given here at much lower doses for their effect on nerves rather than mood. Talking therapies and gullet-focused hypnotherapy also have good evidence and are worth asking about.

Frequently asked questions

What are the Rome IV criteria for reflux hypersensitivity?#

Retrosternal symptoms of heartburn or chest pain; normal endoscopy with no evidence of eosinophilic oesophagitis; no major oesophageal motor disorder; and normal acid exposure on pH or pH-impedance monitoring together with evidence that reflux events trigger the symptoms. Criteria must be fulfilled for three months with onset at least six months earlier, occurring at least twice a week.

How is reflux hypersensitivity different from functional heartburn?#

By the symptom-reflux association alone. Both have normal acid exposure. In reflux hypersensitivity the symptoms coincide with reflux events; in functional heartburn they do not. That difference determines whether acid suppression is worth continuing — in reflux hypersensitivity it often helps partially, while in functional heartburn non-response is a diagnostic criterion.

Does responding to a PPI rule out reflux hypersensitivity?#

No, and this is the key contrast with functional heartburn. A response to acid suppression is entirely compatible with reflux hypersensitivity, because real reflux events are provoking the symptoms even though the total acid burden is normal. Withdrawing a proton pump inhibitor that is helping, on the grounds that the diagnosis is 'functional', misapplies the criteria.

Is reflux hypersensitivity a real disease or just sensitivity?#

It is a recognised Rome IV diagnosis with a demonstrable physiological basis — reflux events reliably provoke symptoms, confirmed on monitoring. What remains genuinely debated is whether it belongs among the functional disorders or at the mild end of the reflux spectrum, since the symptom-reflux association arguably makes it reflux-related. The label earns its place clinically by predicting partial response to acid suppression.

What test is needed to diagnose reflux hypersensitivity?#

pH or pH-impedance monitoring with symptom association analysis, alongside endoscopy with biopsies and high-resolution manometry. The symptom association is essential — a monitoring report giving only acid exposure has answered half the question and cannot distinguish this from functional heartburn.

Can reflux hypersensitivity cause chest pain rather than heartburn?#

Yes. The Rome IV symptom criterion covers retrosternal symptoms including both heartburn and chest pain, which is broader than functional heartburn's requirement for burning specifically. A patient with non-cardiac chest pain and a positive symptom-reflux association has reflux hypersensitivity rather than functional chest pain.

How is reflux hypersensitivity treated?#

Usually a combination: continuing acid suppression or alginates where they give partial benefit, plus a neuromodulator at low dose to address the hypersensitivity itself. Oesophageal-directed hypnotherapy and cognitive behavioural therapy have supporting evidence. Anti-reflux surgery is approached cautiously — the evidence in this group is uncertain rather than clearly against, which differs from functional heartburn.

How often must symptoms occur to meet the criteria?#

At least twice a week, over the last three months, with onset at least six months before diagnosis. That frequency threshold is shared with functional heartburn and is stricter than the once-weekly requirement for functional chest pain, globus and functional dysphagia.

Related calculators

  • Functional Heartburn — Rome IV — heartburn with normal acid exposure
  • Functional Chest Pain — Rome IV — non-cardiac, non-reflux chest pain
  • Globus — Rome IV — painless lump-in-throat sensation
  • Functional Dysphagia — Rome IV — dysphagia with normal endoscopy and manometry
  • Rome IV Criteria for IBS — Irritable bowel syndrome diagnosis and subtype
  • Chicago Classification v4.0 — Oesophageal motility pattern from high-resolution manometry

References

Original / primary reference

  1. Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Esophageal Disorders. Gastroenterology. 2016;150(6):1368-1379 (Rome IV).

Reflux diagnostic framework

  1. Gyawali CP, Yadlapati R, Fass R, Katzka D, Pandolfino J, Savarino E, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361-371.

Clinical practice guidelines

  1. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56.

Last updated July 31, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.