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Background Heartburn is characterized by a discomfort or burning sensation behind the sternum that arises from the epigastrium and may radiate toward the neck. A subset of patients with heartburn are Non-erosive reflux disease (NERD) is characterized by reflux symptoms in the absence of esophageal mucosal breaks, with objective evidence of pathological levels of gastroesophageal reflux on pH or pH-impedance monitoring. Objectives To evaluate patients with heartburn clinically, endoscopically and by combined pH-impedance study. Methodology This is a cross-sectional descriptive study, a total of 60 cases of heartburn, referred to Kurdistan center for Gastroenterology and Hepatology in Sulaimani from February 2015 to December 2015 were enrolled. Cases interviewed and a questionnaire filled; body mass index measured. OGD and pH-impedance study were done for all participants. Results  Out of 60 cases of heartburn, erosive esophagitis (EE) found in 21.7% of cases and 78.7% had normal OGD. Regurgitation found in almost all cases of EE (100%) which was statistically significant (p=0.02). Patients with hiatus hernia HH are at greater risk for EE than non-erosive cases (p=0.01). By OGD and pH-study more than half of our cases (51.6%) were proved to have gastroesophageal reflux disease (GERD). There was significant different (p <0.001) between those with erosive and non-erosive esophagitis in relation to number of reflux episodes and intensity of acid exposure. Conclusion Only 21.3% of heartburn cases had EE. Having HH is a risk factor for EE. Almost half of cases with EE had abnormal pH-study; this means ODG has low sensitivity in the diagnosis of GERD with greater specificity. Adding combined pH-impedance test to OGD in the evaluation of heartburn increase the diagnostic utility of GERD.