An 80-year-old male with coronary artery disease, hypertension, and documented gastroesophageal reux disease (GERD) in the past (Los Angeles grade B erosive esophagitis) presented to clinic for persistent heartburn during both daytime and nighttime despite anti-reux treatment. The patient also reported that nighttime symptoms are causing him to awaken from sleep during the night. He was also complaining of epigastric pain, nausea, and vomiting. He reported no dysphagia or odynophagia but was having choking episodes after swallows and a change in his voice. An upper endoscopy was unremarkable with no evidence of persistent ero­sive esophagitis. A modied barium swallow showed mild laryngeal penetration with nectar thickened barium. His anti-reux regimen at the time consisted of pan­toprazole 40mg daily and ranitidine 300mg at bedtime. His PPI was increased to twice-daily dosing, and he was referred to ENT for evaluation of oropharyngeal dysphagia. Laryngoscopic evaluation revealed postcricoid edema, thought to be related to GERD, and no other abnormalities. He was referred back to the esopha­geal clinic, at which point he underwent pH- impedance testing done while on PPI twice a day, which showed normal acidic or weakly acidic reux, normal reux burden, and negative symptom association (Table1). He was diagnosed with func­tional heartburn. His acid suppression was decreased to PPI once daily, and he was managed with low-dose amitriptyline. He was also referred to psychology for mind­fulness coaching. On follow-up, the patient reported complete resolution of symptoms.