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Functional heartburn is heartburn of unknown cause. It is associated with other functional gastrointestinal disorder like irritable bowel syndrome and is the primary cause of lack of improvement post treatment with proton pump inhibitors (PPIs). PPIs are however still the primary treatment with response rates in about 50% of people. The diagnosis is based upon the Rome III criteria of 1) burning retrosternal discomfort 2) absence of GERD as the cause 3) no esophageal motility disorders. It was found to be present in 22.3% of Canadians in one survey.