ToolsCalculators
Rome IV Diagnostic Criteria for Reflux Hypersensitivity
Diagnosis of reflux-triggered esophageal symptoms despite physiologic acid exposure.
Rome IV Diagnostic Criteria for Reflux Hypersensitivity
Retrosternal symptoms, including heartburn and chest pain, at least twice weekly
Normal endoscopy, with eosinophilic esophagitis excluded as the cause
Absence of a major esophageal motor disorder
Positive symptom-reflux association on pH or pH-impedance monitoring despite physiologic (normal) esophageal acid exposure
Onset ≥6 months ago, with criteria fulfilled for the last 3 months
ResultCriteria not met
Does not meet Rome IV criteria for reflux hypersensitivity; reconsider erosive/non-erosive GERD, functional heartburn, eosinophilic esophagitis, or a major esophageal motor disorder.
When to use
- Retrosternal symptoms with normal endoscopy, where reflux monitoring shows normal acid exposure but symptoms correlate temporally with reflux events, distinguishing this entity from functional heartburn (no symptom-reflux correlation).
Formula
Diagnosis requires all of: retrosternal symptoms (heartburn/chest pain) at least twice weekly; normal endoscopy with eosinophilic esophagitis excluded; no major esophageal motor disorder; positive symptom association with reflux events despite physiologic acid exposure on pH/impedance monitoring; onset ≥6 months before diagnosis with criteria met for the last 3 months.
Pearls and pitfalls
- Distinguished from functional heartburn by a positive symptom-reflux association; both share normal endoscopy and physiologic acid exposure.