Indeed, a recent clinical review confirms that the clinical need for the PPI test increases as the true prevalence of GERD in esophageal (erosive, non-erosive reflux disease, non-cardiac chest pain) and extraesophageal syndromes decreases. Recently, the Rome III committee suggested that lack of response to full course of PPI is mandatory for the diagnosis of functional heartburn 176]. They also recognized that patients with a normal PPI test and endoscopy, but who respond to PPI treatment should be considered as having GERD. A limitation of the test is that in a case of a negative response the diagnostic utility of endoscopy is limited as that the putative presence of mucosal injury, which is highly specific for GERD, will likely be healed (491. In addition,