{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T09:44:51Z","timestamp":1776764691683,"version":"3.51.2"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>SUMMARY<\/jats:title>\n                  <jats:p>Functional heartburn (FH) is typically diagnosed by 24-hour multichannel intraluminal impedance\u2013pH (MII-pH) monitoring; however, relying solely on 24-hour MII-pH may miss gastroesophageal reflux events due to day-to-day variability. In addition, since FH is a diagnosis of exclusion, other underlying conditions may be undiagnosed. This study aimed to assess the clinical course of FH and identify potential alternative diagnoses. Patients with heartburn refractory to proton pump inhibitors or potassium-competitive acid blockers who underwent endoscopy, high-resolution manometry, and MII-pH monitoring after discontinuation of acid-suppressive therapy and met diagnostic criteria for FH were retrospectively analyzed. Symptom severity was assessed using the frequency scale for the symptoms of GERD. Of 114 patients with refractory heartburn, 46 (40.4%) were diagnosed with FH. Of them, 42 patients were included in the analysis. During a mean follow-up of 18.1\u00a0months, six patients underwent hypopharyngeal impedance\u2013pH monitoring, and four were diagnosed with laryngopharyngeal reflux disease; one of them underwent laparoscopic anti-reflux surgery, resulting in symptomatic improvement. Additionally, one patient each was diagnosed with unstable angina, atlantoaxial subluxation, major depressive disorder, bipolar disorder, and somatoform disorder. Patients with unstable angina and atlantoaxial subluxation underwent the treatment of underlying conditions and had complete resolution of symptoms. Approximately 20% of patients initially diagnosed with FH were subsequently found to have alternative diagnoses. One-time, conventional 24-hour MII-pH testing may not be accurate to diagnose FH. Therefore, even after the initial diagnosis of FH, a meticulous long-term follow-up remains essential to identify initially unrecognized conditions.<\/jats:p>","DOI":"10.1093\/dote\/doag034","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:35:48Z","timestamp":1774956948000},"source":"Crossref","is-referenced-by-count":0,"title":["Limitations of 24-hour MII-pH monitoring to diagnose functional heartburn: a diagnostic reassessment"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5314-9325","authenticated-orcid":false,"given":"Tomoaki","family":"Matsumura","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiko","family":"Sonoda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshitaka","family":"Hoppo","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Seki","sequence":"additional","affiliation":[{"name":"Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomomi","family":"Ozaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satsuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromi","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miyuki","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsubasa","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Ohta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Taida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hang Viet","family":"Dao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]},{"name":"Internal Medicine Faculty, Hanoi Medical University , Hanoi ,","place":["Vietnam"]},{"name":"The Institute of Gastroenterology and Hepatology , Hanoi ,","place":["Vietnam"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuko","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineering Center, Chiba University Hospital , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichiro","family":"Okimoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Chiba University , Chiba ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"2026042104522243400_ref1","doi-asserted-by":"publisher","first-page":"265","DOI":"10.5056\/jnm14075","article-title":"Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless pH monitoring in patients with proton pump inhibitor-refractory gastroesophageal reflux disease","volume":"21","author":"Penagini","year":"2015","journal-title":"J Neurogastroenterol Motil"},{"key":"2026042104522243400_ref2","doi-asserted-by":"publisher","first-page":"335","DOI":"10.5056\/jnm22130","article-title":"Extended wireless pH monitoring significantly increases gastroesophageal reflux disease diagnoses in patients with a normal pH impedance study","volume":"29","author":"Zeki","year":"2023","journal-title":"J Neurogastroenterol Motil"},{"key":"2026042104522243400_ref3","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1007\/s00535-004-1417-7","article-title":"Development and evaluation of FSSG: frequency scale for the symptoms of GERD","volume":"39","author":"Kusano","year":"2004","journal-title":"J Gastroenterol"},{"key":"2026042104522243400_ref4","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1001\/jamasurg.2013.1376","article-title":"Antireflux surgery in patients with chronic cough and abnormal proximal exposure as measured by hypopharyngeal multichannel intraluminal impedance","volume":"148","author":"Hoppo","year":"2013","journal-title":"JAMA Surg"},{"key":"2026042104522243400_ref5","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1097\/MEG.0b013e32835b108f","article-title":"Functional heartburn: clinical characteristics and outcome","volume":"25","author":"Blaga","year":"2013","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2026042104522243400_ref6","doi-asserted-by":"publisher","first-page":"69","DOI":"10.5056\/jnm20228","article-title":"Reflux-related extraesophageal symptoms until proven otherwise: a direct measurement of abnormal proximal exposure based on hypopharyngeal multichannel intraluminal impedance as a reliable indicator for successful treatment outcomes","volume":"28","author":"Suzuki","year":"2022","journal-title":"J Neurogastroenterol Motil"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/2\/doag034\/68119245\/doag034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/2\/doag034\/68119245\/doag034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T08:52:27Z","timestamp":1776761547000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doag034\/8659649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":6,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doag034","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,2]]},"article-number":"doag034"}}