Rengarajan A, Pomarat M, Zerbib F, et al. - Researchers conducted this prospective cohort study to compare the clinical and psychological profiles of conventional reflux hypersensitivity (RH) and functional heartburn (FH) to overlap RH and FH that were introduced as working hypotheses by ROME IV. Adult patients with heartburn had pH-impedance testing on therapy (proven GERD) and off therapy (unproven GERD) and finished validated questionnaires defining symptoms (Reflux Diagnostic Questionnaire, RDQ), affective state (Hospital Anxiety and Depression Scale, HADS; Visceral Sensitivity Index, VSI), and functional diagnoses (irritable bowel syndrome, IBS; functional dyspepsia, FD on ROME diagnostic questionnaire). Patients in the study included 19 with RH (10 with overlap RH), 60 with FH (31 with overlap FH), and 26 with non-erosive reflux disease (NERD). Clinical, psychological, and functional profiles of conventional FH/RH were comparable to overlap FH/RH. Combined FH and RH cohorts had higher anxiety scores and lower proportions of IBS than NERD. FH defined using both normal AET and normal mean nocturnal baseline impedance (MNBI) had higher depression scores and a trend toward higher anxiety scores when compared with FH with low MNBI. Conventional and overlapping FH and RH have clinical, psychological, and functional profiles that are similar, proving the ROME IV hypotheses.