A Patient’s Story
John, 42, had lived with a burning sensation behind his chest for years. Heart tests were normal. Acid reflux treatment did not help. Multiple scans showed nothing wrong.
Yet the pain kept returning, often after meals. Eventually, John learned he was not imagining his symptoms. He had functional heartburn.
What Is Functional Heartburn?
Functional heartburn causes heartburn-like chest pain without evidence of acid reflux, inflammation, or structural disease of the oesophagus.
Unlike GORD, there is:
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No damage to the oesophageal lining
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Normal acid exposure on testing
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Poor response to standard acid-suppressing medication
It is classified as a disorder of gut–brain interaction, where pain perception is altered rather than caused by acid injury.
Functional Heartburn vs GORD
Although symptoms overlap, the mechanism is different.
GORD
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Excess acid reflux
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Oesophageal inflammation
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Improves with PPIs
Functional Heartburn
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Normal acid levels
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No visible damage
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Symptoms persist despite PPIs
This distinction is critical, as treatment approaches differ.
Read more about GORD
Common Symptoms
Symptoms often fluctuate and occur during the daytime.
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Burning pain behind the breastbone
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Symptoms after meals
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Belching or bloating
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Upper abdominal discomfort
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Feeling full quickly
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Regurgitation without acid damage
Functional heartburn may coexist with IBS or functional dyspepsia.
Why Does Functional Heartburn Occur?
The exact cause is complex, but key mechanisms include:
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Visceral hypersensitivity
Normal sensations are perceived as pain. -
Altered gut–brain signalling
The nervous system amplifies oesophageal sensations. -
Stress and psychological triggers
Anxiety and stress can worsen symptoms.
In some cases, mild acid exposure triggers pain due to heightened sensitivity, even though acid levels are normal.
How Is Functional Heartburn Diagnosed?
Diagnosis focuses on excluding other causes.
Tests may include:
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Gastroscopy to rule out inflammation
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pH monitoring to assess acid exposure
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Impedance testing to exclude reflux episodes
If findings are normal and symptoms persist, functional heartburn is diagnosed.
Treatment Options
Treatment is personalised and often multimodal.
Lifestyle strategies
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Regular meals
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Stress reduction
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Sleep optimisation
Medications
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Low-dose neuromodulators to reduce pain signalling
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Limited role for PPIs unless acid sensitivity is proven
Gut–brain therapies
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Gut-directed hypnotherapy
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Cognitive behavioural approaches
The goal is symptom control, not acid suppression.
Why Specialist Care Matters
Functional heartburn is frequently misdiagnosed, leading to:
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Prolonged PPI use
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Ongoing symptoms
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Patient frustration
A specialist approach ensures accurate diagnosis and targeted treatment, avoiding unnecessary medication.
Book a Specialist Assessment
Persistent heartburn with normal tests?
If your symptoms persist despite treatment, a functional cause should be considered. A specialist assessment can help identify the true driver of your symptoms and guide effective management.