# Rome IV functional heartburn

Rome IV Heartburn

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/rome_iv_heartburn`
HTML: https://magentlab.com/docs/rome-iv-heartburn
Markdown: https://magentlab.com/docs/rome-iv-heartburn.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Aziz 2016 Rome IV functional heartburn diagnostic criteria and return whether the published functional heartburn box holds (rome_iv_heartburn).

## When to use

When an agent already has the six caller-assigned Aziz 2016 Rome IV functional heartburn flags and needs whether the published box holds. magent does not prescribe PPI or read pH-impedance.

## When not to use

- Not a medical device.
- Not a diagnosis. magent does not diagnose functional heartburn.
- The caller assigns the six flags. magent does not prescribe PPI or read pH-impedance.
- This tool is Aziz 2016 Rome IV functional heartburn only. Not globus. Not reflux hypersensitivity as the primary tool. Not Rome IV IBS (Mearin 2016).

## Formula

```
rome_iv_heartburn iff burning_retrosternal_discomfort and no_relief_despite_optimal_antisecretory_therapy and not_explained_by_gerd_or_eoe and no_major_esophageal_motor_disorder and fulfilled_last_3_months and onset_at_least_6_months (Aziz 2016 Rome IV functional heartburn)
```

## Citation

[Esophageal Disorders](https://doi.org/10.1053/j.gastro.2016.02.012)
Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F
Gastroenterology. 2016;150(6):1368-1379
DOI: [10.1053/j.gastro.2016.02.012](https://doi.org/10.1053/j.gastro.2016.02.012)

## Worked example

### All six required flags

Given: `burning_retrosternal_discomfort=true, fulfilled_last_3_months=true, no_major_esophageal_motor_disorder=true, no_relief_despite_optimal_antisecretory_therapy=true, not_explained_by_gerd_or_eoe=true, onset_at_least_6_months=true`

1. Burning retrosternal discomfort or pain is true
2. No relief despite optimal antisecretory therapy is true
3. Symptoms are not explained by GERD or eosinophilic esophagitis
4. No major esophageal motor disorder is true
5. Criteria fulfilled for the last 3 months and onset at least 6 months prior are true
6. rome_iv_heartburn is true


### Five required flags without 6-month onset

Given: `burning_retrosternal_discomfort=true, fulfilled_last_3_months=true, no_major_esophageal_motor_disorder=true, no_relief_despite_optimal_antisecretory_therapy=true, not_explained_by_gerd_or_eoe=true, onset_at_least_6_months=false`

1. Five required flags hold
2. Onset at least 6 months prior is false
3. rome_iv_heartburn is false


## Also searched as

- Rome IV functional heartburn
- Aziz 2016 functional heartburn
- functional heartburn Rome IV
- Rome IV heartburn
- esophageal functional heartburn
- functional heartburn criteria
- Rome IV esophageal heartburn
- heartburn without GERD

## Parameters

- `burning_retrosternal_discomfort` (boolean, required): Burning retrosternal discomfort or pain, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not examine the patient.
- `no_relief_despite_optimal_antisecretory_therapy` (boolean, required): No symptom relief despite optimal antisecretory therapy, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not prescribe PPI.
- `not_explained_by_gerd_or_eoe` (boolean, required): Symptoms not explained by GERD or eosinophilic esophagitis, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not read pH-impedance.
- `no_major_esophageal_motor_disorder` (boolean, required): Absence of a major esophageal motor disorder, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not interpret manometry.
- `fulfilled_last_3_months` (boolean, required): Criteria fulfilled for the last 3 months, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not take a history.
- `onset_at_least_6_months` (boolean, required): Symptom onset at least 6 months prior to diagnosis, as assigned (Aziz 2016). true or false as assigned by the caller. magent does not take a history.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/rome_iv_heartburn`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "burning_retrosternal_discomfort": "true",
      "fulfilled_last_3_months": "true",
      "no_major_esophageal_motor_disorder": "true",
      "no_relief_despite_optimal_antisecretory_therapy": "true",
      "not_explained_by_gerd_or_eoe": "true",
      "onset_at_least_6_months": "true"
    },
    {
      "burning_retrosternal_discomfort": "true",
      "fulfilled_last_3_months": "true",
      "no_major_esophageal_motor_disorder": "true",
      "no_relief_despite_optimal_antisecretory_therapy": "true",
      "not_explained_by_gerd_or_eoe": "true",
      "onset_at_least_6_months": "true"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-heartburn

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/rome_iv_heartburn",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F",
        "doi": "10.1053/j.gastro.2016.02.012",
        "id": "aziz-2016",
        "pmid": "27144654",
        "source": "Gastroenterology. 2016;150(6):1368-1379",
        "title": "Esophageal Disorders"
      },
      "formula": "rome_iv_heartburn",
      "formula_expression": "rome_iv_heartburn iff burning_retrosternal_discomfort and no_relief_despite_optimal_antisecretory_therapy and not_explained_by_gerd_or_eoe and no_major_esophageal_motor_disorder and fulfilled_last_3_months and onset_at_least_6_months (Aziz 2016 Rome IV functional heartburn)",
      "criteria": [
        {
          "factor": "burning_retrosternal_discomfort",
          "met": true
        },
        {
          "factor": "no_relief_despite_optimal_antisecretory_therapy",
          "met": true
        },
        {
          "factor": "not_explained_by_gerd_or_eoe",
          "met": true
        },
        {
          "factor": "no_major_esophageal_motor_disorder",
          "met": true
        },
        {
          "factor": "fulfilled_last_3_months",
          "met": true
        },
        {
          "factor": "onset_at_least_6_months",
          "met": true
        }
      ],
      "rome_iv_heartburn": true
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F",
        "doi": "10.1053/j.gastro.2016.02.012",
        "id": "aziz-2016",
        "pmid": "27144654",
        "source": "Gastroenterology. 2016;150(6):1368-1379",
        "title": "Esophageal Disorders"
      },
      "formula": "rome_iv_heartburn",
      "formula_expression": "rome_iv_heartburn iff burning_retrosternal_discomfort and no_relief_despite_optimal_antisecretory_therapy and not_explained_by_gerd_or_eoe and no_major_esophageal_motor_disorder and fulfilled_last_3_months and onset_at_least_6_months (Aziz 2016 Rome IV functional heartburn)",
      "criteria": [
        {
          "factor": "burning_retrosternal_discomfort",
          "met": true
        },
        {
          "factor": "no_relief_despite_optimal_antisecretory_therapy",
          "met": true
        },
        {
          "factor": "not_explained_by_gerd_or_eoe",
          "met": true
        },
        {
          "factor": "no_major_esophageal_motor_disorder",
          "met": true
        },
        {
          "factor": "fulfilled_last_3_months",
          "met": true
        },
        {
          "factor": "onset_at_least_6_months",
          "met": true
        }
      ],
      "rome_iv_heartburn": true
    }
  ]
}
```

## Response fields

- `formula` (string): rome_iv_heartburn
- `formula_expression` (string): Aziz 2016 Rome IV functional heartburn: burning retrosternal discomfort, no relief despite optimal antisecretory therapy, not explained by GERD or EoE, no major esophageal motor disorder, last-3-months criteria, and 6-month onset
- `rome_iv_heartburn` (boolean): true only when all six required flags hold. Not a diagnosis.
- `criteria` (array): Per-factor rows with factor and met for the six required flags
- `citation` (object): Aziz 2016 Gastroenterology citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F",
    "doi": "10.1053/j.gastro.2016.02.012",
    "id": "aziz-2016",
    "pmid": "27144654",
    "source": "Gastroenterology. 2016;150(6):1368-1379",
    "title": "Esophageal Disorders"
  },
  "formula": "rome_iv_heartburn",
  "formula_expression": "rome_iv_heartburn iff burning_retrosternal_discomfort and no_relief_despite_optimal_antisecretory_therapy and not_explained_by_gerd_or_eoe and no_major_esophageal_motor_disorder and fulfilled_last_3_months and onset_at_least_6_months (Aziz 2016 Rome IV functional heartburn)",
  "criteria": [
    {
      "factor": "burning_retrosternal_discomfort",
      "met": true
    },
    {
      "factor": "no_relief_despite_optimal_antisecretory_therapy",
      "met": true
    },
    {
      "factor": "not_explained_by_gerd_or_eoe",
      "met": true
    },
    {
      "factor": "no_major_esophageal_motor_disorder",
      "met": true
    },
    {
      "factor": "fulfilled_last_3_months",
      "met": true
    },
    {
      "factor": "onset_at_least_6_months",
      "met": true
    }
  ],
  "rome_iv_heartburn": true
}
```

## Errors

- HTTP 400 `invalid_rome_iv_heartburn`: Rome IV functional heartburn needs the Aziz 2016 esophageal heartburn flags. Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Rome IV globus](https://magentlab.com/docs/rome-iv-globus) — Apply the Aziz 2016 Rome IV esophageal globus diagnostic criteria and return whether the published globus box holds (rome_iv_globus).
- [Rome IV FD](https://magentlab.com/docs/rome-iv-fd) — Apply the Stanghellini 2016 Rome IV B1 functional dyspepsia criteria and return whether PDS (B1a), EPS (B1b), and the published FD box hold (rome_iv_fd).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.