Some patients with symptoms of gastroesophageal reflux have normal findings on exam. The theory is that the patient is hypersensitive to "normal" acid reflux.
Criteria for the diagnosis of reflux hypersensitivity:
(1) presence of retrosternal symptoms (heartburn, chest pain)
(2) normal upper GI endoscopy
(3) normal acid exposure on pH or pH-impedance monitoring (absence of acid burden)
(4) absence of evidence for eosinophilic esophagitis
(5) absence of esophageal motor disorder (achalasia, spasm, etc)
A response to therapy to reduce acid secretion does not exclude the diagnosis.
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